Single-Access Retrieval of a Ruptured Balloon During Balloon-Expandable TAVI

Background: Balloon-expandable valves are among the most commonly used platforms for transfemoral transcatheter aortic valve implantation (TAVI). Although deployment-related complications are uncommon, balloon rupture with distal fragment retention is a rare but technically demanding scenario with no standardized retrieval protocol. Case Summary: A 79-year-old patient underwent a transfemoral TAVI with a balloon-expandable valve. Balloon rupture during deployment resulted in partial retention of the distal balloon segment. The patient remained hemodynamically stable without annular or aortic injury. The retained fragment was successfully retrieved through the same femoral access site using a snare-based technique, without contralateral large-bore access or surgical conversion. Discussion: Same-access snaring through the ipsilateral E-sheath—after correcting the deformed tip to restore coaxial alignment—allows safe, controlled extraction of the retained balloon fragments through a single-access site. Recognizing and correcting sheath tip deformation before snare advancement is a critical technical prerequisite. Take-Home Messages: Balloon rupture during balloon-expandable TAVI may result in retained balloon fragments. Same-access snaring through the ipsilateral E-sheath is a feasible and safe first-line strategy. Sheath deformation must be recognized and corrected to ensure successful extraction without escalation to additional access or surgery.