Balloon Rupture During Myval TAVI: A Rare Complication and Successful Bailout Strategy

Abstract

Balloon rupture during transcatheter aortic valve implantation (TAVI) is a rare but life-threatening complication. We report a successful bailout strategy following TAVI balloon rupture during the deployment of a 24.5 mm Myval valve. Upon partial inflation failure, the valve and ruptured balloon were retracted into the descending aorta. To overcome friction, diluted propofol (1 mg in 10 mL saline) was injected through the balloon lumen as a chemical lubricant, facilitating safe balloon disengagement. Following en bloc removal of the damaged system and placement of a new sheath, the first valve was intentionally deployed in the descending aorta using a sequential balloon expansion strategy (20 mm followed by 27.5 mm). A second 24.5 mm Myval valve was subsequently implanted at the native annulus without complications. This case highlights the novel use of propofol lubrication as a rapid, effective endovascular bailout technique.