# Aortic Valve Leaflet Avulsion After Transcatheter Aortic Valvuloplasty: A Case Series and Literature Review

## TL;DR

This paper reports two cases of aortic valve leaflet avulsion after TAVR and suggests conservative management may be effective in some cases.

## Contribution

The paper contributes two new clinical cases of AVLA after TAVR and proposes conservative management as a potential treatment approach.

## Key findings

- Two patients with AVLA after TAVR were managed conservatively with anticoagulation and aspirin.
- Both patients had uneventful hospital courses and functional bioprostheses on follow-up.
- Conservative management may be appropriate for AVLA without embolic or ischemic symptoms.

## Abstract

Aortic valve leaflet avulsion (AVLA) is recognized as a life-threatening adverse event that significantly affects patient hemodynamics, often leading to additional intervention.

We report 2 cases from our institution of AVLA after transcatheter aortic valve replacement (TAVR). The patients had a highly mobile mass on the aortic annulus and the left ventricular outflow tract, respectively.

In both cases, a multidisciplinary team discussion resulted in the decision to monitor the patients for 48 hours for neurovascular changes while on therapeutic anticoagulation, and both patients were discharged on anticoagulants and low-dose aspirin. Their hospital courses were uneventful, and normally functional aortic valve bioprostheses were noted on follow-up.

The literature on AVLA after TAVR remains limited. The current treatment approaches for AVLA are primarily invasive, including surgical repair of the valve or snaring of avulsed structures.

Conservative management may be appropriate in post-TAVR AVLA cases without ischemic or embolic manifestation.