A Dilemma in the Extremely Low-Placed Venus A-Valve in a Cardiogenic Shock Patient


  • Mi Chen, MD Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Honglei Zhao, MD, PhD Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Yan Ding, MD Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • Lizhong Sun, MD, PhD Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China




Transcatheter aortic valve replacement, paravalvular aortic regurgitation, transcatheter heart valve


Transcatheter aortic valve replacement (TAVR) is regarded as an alternative to balloon aortic valvuloplasty in patients with severe aortic valve stenosis in cardiogenic shock. A low implantation of transcatheter heart valve (THV) can result in “supraskirt” paravalvular aortic regurgitation (PAR) and prosthesis-patient mismatch (P-PM), causing a dilemma in such a setting. A 64-year-old man presented to our emergency department with severe aortic stenosis and acute heart failure causing cardiogenic shock. An urgent transfemoral TAVR was performed under general anesthesia in a hybrid room. Predilatation was performed with a 22-mm compliant balloon, and a 26-mm Venus A-Valve (Venus MedTech, Hangzhou, China) was deployed. After valve implantation, the hemodynamic conditions of the patient rapidly deteriorated; therefore, cardiopulmonary resuscitation and extracorporeal circulation support were initiated. Aortography and transthoracic echocardiography (TEE) illustrated an extremely low implantation of THV, with moderate to severe supraskirt PAR and moderate P-PM. After evaluation of the hemodynamic tolerability of PAR, a median sternotomy was done, and surgery was performed. The patient died due to severe sepsis and hyperkalemia 14 days after the procedure. The management of urgent TAVR in cardiogenic shock should be revised and reexamined. A widespread and practical percutaneous technique to manage implant failure of THV is required to avoid surgical bailout.


Auer J, Grund M, Puschmann R, Berent R. Acute severe mitral stenosis immediately after transcatheter aortic valve implantation. J Invasive Cardiol 2017;29:E154.

Balghith M, Omran A, Saileek A, Alghamdi A, Najm H. Transcatheter aortic valve implantation (core valve) prosthesis complicated by mitral stenosis. J Saudi Heart Assoc 2012;24:149-150.

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-2791.

Fraccaro C, Campante Teles R, Tchetche D, Saia F, Bedogni F, Montorfano M, et al. Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI-shock registry results. Catheter Cardiovasc Interv 2020;96:1128-1135.

Franco E, de Agustin JA, Hernandez-Antolin R, Garcia E, Silva J, Maroto L, et al. Acute mitral stenosis after transcatheter aortic valve implantation. J Am Coll Cardiol 2012;60:e35.

Geisbusch S, Bleiziffer S, Mazzitelli D, Ruge H, Bauernschmitt R, Lange R. Incidence and management of CoreValve dislocation during transcatheter aortic valve implantation. Circ Cardiovasc Interv 2010;3:531-536.

Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: Device success and 30-day clinical outcome. J Am Coll Cardiol 2007;50:69-76.

Harries I, Chandrasekaran B, Barnes E, Ramcharitar S. Iatrogenic mitral stenosis following transcatheter aortic valve replacement (TAVR). Indian Heart J 2015;67:60-61.

Ibebuogu UN, Giri S, Bolorunduro O, Tartara P, Kar S, Holmes D, et al. Review of reported causes of device embolization following trans-catheter aortic valve implantation. Am J Cardiol 2015;115:1767-1772.

Jilaihawi H, Chin D, Spyt T, Jeilan M, Vasa-Nicotera M, Bence J, et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis. Eur Heart J 2010;31:857-864.

Makkar RR, Jilaihawi H, Chakravarty T, Fontana GP, Kapadia S, Babaliaros V, et al. Determinants and outcomes of acute transcatheter valve-in-valve therapy or embolization: A study of multiple valve implants in the U.S. PARTNER trial (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve). J Am Coll Cardiol 2013;62:418-430.

Piazza N, Schultz C, de Jaegere PP, Serruys PW. Implantation of two self-expanding aortic bioprosthetic valves during the same procedure—Insights into valve-in-valve implantation (“Russian doll concept”). Catheter Cardiovasc Interv 2009;73:530-539.

Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgitation following TAVR: A proposal of unifying grading scheme. JACC Cardiovasc Imaging 2015;8:340-360.

Sarkar K, Ussia G, Tamburino C. Core Valve embolization: Technical challenges and management. Catheter Cardiovasc Interv 2012;79:777-782.

Tang GHL, Zaid S, Michev I, Ahmad H, Kaple R, Undemir C, et al. “Cusp-overlap” view simplifies fluoroscopy-guided implantation of self-expanding valve in transcatheter aortic valve replacement. JACC Cardiovasc Interv 2018;11:1663-1665.

Tay EL, Gurvitch R, Wijeysinghe N, Nietlispach F, Leipsic J, Wood DA, et al. Outcome of patients after transcatheter aortic valve embolization. JACC Cardiovasc Interv 2011;4:228-234.

Ussia GP, Barbanti M, Imme S, Scarabelli M, Mule M, Cammalleri V, et al. Management of implant failure during transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2010;76:440-449.

Ussia GP, Barbanti M, Ramondo A, Petronio AS, Ettori F, Santoro G, et al. The valve-in-valve technique for treatment of aortic bioprosthesis malposition an analysis of incidence and 1-year clinical outcomes from the italian CoreValve registry. J Am Coll Cardiol 2011;57:1062-1068.



How to Cite

Chen, M., Zhao, H., Ding, Y., & Sun, L. (2021). A Dilemma in the Extremely Low-Placed Venus A-Valve in a Cardiogenic Shock Patient. The Heart Surgery Forum, 24(2), E256-E260. https://doi.org/10.1532/hsf.3517