Recurrent balloon rupture during Transcatheter Aortic Valve Replacement (TAVR) - a challenge to the Hybrid team.

Results We were successful in deploying a 26 mm Edwards Sapien XT through trans-aortic approach after two failed attempt due to rupture of the balloon during valvuloplasty. The patient also had an off pump coronary artery bypass grafting to the right coronary artery. The patient was discharged home after a week. Discussion/Conclusion TAVR balloon rupture is an uncommon complication; it could result when the balloon expands against a sharp spike of calcium as it was in this case. The issue of retrieving the balloon could be complicated in such scenarios particularly if the access was through a transfemoral route. In such a situation the retrieval of the balloon and sheath system would require pulling back the delivery system into the descending aorta and performing a potentially complicated unplanned ilio-femoral vascular exploration. On the other hand, the appearances of sharp spike-like calcifications would favour the trans-aortic approach where retrieval of the system if the balloon ruptures is more straightforward. Pre-operative Computed tomography is very essential in selecting the best access for trans catheter valve.