How should I treat an Edwards SAPIEN 3 aortic valve embolisation during a transaortic transcatheter aortic valve implantation?

BACKGROUND: A 91-year-old gentleman with a symptomatic severe aortic valve stenosis and chronic kidney disease was referred to our hospital for evaluation. INVESTIGATION: Valve area: 0.5 cm2 with a mean transaortic gradient of 52 mmHg. EuroSCORE II: 15.24% and STS score: 10%. The Heart Team decided to implant a balloon-expandable Edwards SAPIEN 3 transcatheter valve via a transaortic approach (important peripheral disease). DIAGNOSIS: During inflation, the Edwards SAPIEN 3 valve expanded asymmetrically and embolised in the ascending aorta where it remained stuck onto the outside lumen of the sheath in a half-deployed conformation. MANAGEMENT: After different manoeuvres, the valve was successfully uncoupled from the sheath but a complete valve expansion had to be performed, leaving the valve floating in the ascending aorta. Using a transfemoral route, the valve was captured and inflated in the aortic arch.