ABSTRACT
Background: Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe aortic stenosis, but is still associated with a risk of major vascular complication. Case summary: An elective transfemoral TAVI was undertaken for severe aortic stenosis. During delivery of a 26mm Sapien S3 valve, the delivery system sheath (eSheath) split prematurely. The valve could not be advanced, and lay parallel to the sheath body. Following advice, an attempt was made to remove the system en bloc but this was unsuccessful. After careful consideration of alternative options, the valve was advanced with reasonable force and the case was completed successfully. The femoral artery was closed with parclose sutures without major vascular complication. Discussion: Early recognition of a split sheath with effective communication between lab team members and the manufacturer allowed us to successfully navigate this case, with a good outcome for our patient.