Surgical management of native aortic valve leaflet avulsion during TAVR

Transcatheter aortic valve replacement (TAVR) has increased in utilization since its approval for management of aortic stenosis patients across all risk strata. We report a rare case of aortic valve leaflet avulsion after balloon expandable TAVR managed with urgent surgery.

A 78-year-old male underwent TAVR complicated by avulsion of the native aortic valve leaflet’s left coronary cusp. He was taken for urgent surgery for cusp resection to prevent thromboembolic complications.

Native aortic valve leaflet avulsion should be suspected during TAVR in instances of extreme hemodynamic instability after balloon aortic valvuloplasty. As TAVR expands in lower risk patients, surgeons should have a low threshold to intervene surgically to treat native leaflet avulsion or other complications.