Acute intraventricular migration of a transcatheter aortic prosthesis

We describe a low-risk patient who underwent transcatheter aortic valve implantation after refusing conventional surgery. During the procedure, prosthesis migration into the left ventricle prompted emergency surgical aortic valve replacement. Transcatheter aortic valve implantation is currently indicated in high-risk patients with aortic stenosis; its role in intermediate-risk subjects remains controversial, while in low-risk patients, surgery is still the procedure of choice. Because of such severe unpredictable procedure-related complications, the management of low-risk patients refusing surgery may be difficult. Whether the heart team should also consider potential ethical and economic aspects remains to be defined.