Acute Antegrade TAVI Migration Successfully Treated with Snare Utilization and Near Valve-in-Valve (Viv) Implantation

, Abstract 90-year-old woman admitted urgently in Cardiology ward at New Cross with acute heart failure symptoms on background of severe aortic stenosis. Also reported previous syncopal episodes. On admission echocardiogram performed which revealed aortic valve area of 0.48 cm 2 and mean pressure gradient of 41mmHg. Her Left Ventricular Ejection Fraction was 35%. After stabilizing her with diuresis, she underwent computed tomography TAVI workup.This revealed reasonable ilio-femoral access and estimation of valvular annular size undertaken. Trans-catheter aortic valve implantation eventually took place. Ultrasound guidance used to gain access.6Fr sheath inserted into left femoral artery (graduated pigtail for aortogram),7Fr into left femoral vein (temporary pacing wire) and 6Fr into right femoral artery (RFA) which was pre-closed with 2 Proglides and upgraded to 9Fr sheath. Immediately,the aortic valve crossed in conventional manner and a 26mm Medtronic Evolut pro was implanted [1]. Unfortunately post release the valve migrated into ascending aorta,with pendular movements in an aneurysmal aorta [2]. As the patient was haemodynamically stable we implanted a larger valve after snaring the