This is a 73-year-old male (height: 162.6 cm, weight: 59.3 kg, BMI: 23.3) presenting with New York Heart Association (NYHA) Class II dyspnea on exertion (DOE).                                                                                   
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2-2.avi

Findings show severe aortic stenosis (EOA 0.56cm², gradients 63/41mmHg, Vmax 4.0m/s). LVEF is 28% with biventricular dysfunction and LA enlargement. History includes atrial fibrillation with RVR and prior stroke. PFTs indicate an obstructive pattern (FEV1 64%, FVC 74%, ratio 0.58). STS score is 3.6% (intermediate risk).

TAVR performed with 26mm SAPIEN 3 valve (Edwards) with excellent deployment and positioning. Predilation completed, valve implanted under fluoroscopic guidance with full expansion and appropriate seating. Post-deployment echo: no paravalvular leak, no AR, no pericardial effusion. Hemodynamics stable with no conduction disturbances or complications.

TAVR was performed with a 26 mm SAPIEN 3 valve using left CFA access. The initial Pre-closure closure failed, resulting in left CFA dissection and occlusion. This was managed through a contralateral approach by rewiring the left CFA using an 014 wire and MCT CXI catheter. Balloon tamponade was applied to control bleeding. A subsequent Proglide deployment was performed via the remaining left-side wire, followed by successful hemostasis using a Femoseal device. The procedure concluded without additional complications.

5-4.avi

In cases where initial pre-closure fails, the presence of a large access site created by the TAVR delivery system increases the likelihood of subsequent Proglide deployment failure. However, as demonstrated in this case, a contralateral approach with balloon tamponade can reduce the large access site and enhance the success rate of Proglide reattempts.