Re-sheathing failure with Navitor during transcatheter aortic valve implantation: a case report

Background. Self-expanding valves used in transcatheter aortic valve implantation (TAVI) are designed to allow recapture and repositioning, facilitating optimal placement and mitigating conduction disturbances and paravalvular leakage. Here, we present a rare case in which the Navitor (Abbott Structural Heart, Santa Clara, CA, USA) could not be recaptured. Case summary. An 81-year-old Japanese woman with very severe aortic stenosis and a massively calcified nodule at the non-coronary cusp (NCC) underwent TAVI with a 25 mm Navitor valve. During the initial deployment attempt, non-uniform expansion (NUE) was observed on the NCC side when the valve was 80% deployed. An attempt was made to recapture and reposition the valve, but the delivery system capsule failed to fully re-sheath the prosthesis, leaving approximately one-third of the valve outside the capsule and preventing complete recapture. The Navitor was promptly redeployed while still within the basal ring. Following redeployment, the NUE resolved, and the valve was successfully positioned 3 mm below the basal ring on the NCC side and 4 mm below the left coronary cusp. We hypothesized that interference between the capsule tip and the calcified nodule on the NCC leaflet inhibited the re-sheathing process. Conclusion. This report documents a rare complication involving the failure to recapture the Navitor valve. In cases with large calcified nodules on the leaflet, caution is essential during the re-sheathing process. We strongly recommend re-deploying the prosthesis rather than attempting to remove it from the basal ring to minimize procedural risks and ensure proper valve placement.