Late displacement and ineffective retensioning of a transapical transcatheter mitral prosthesis

The Tendyne valve (Abbott Structural) is a self-expanding, nitinol prothesis with a double-frame design that contains a trileaflet porcine pericardial valve anatomically shaped for the mitral annulus. The prosthesis, which is delivered via a 34Fr transapical sheath, is uniquely anchored with a tether connected to an epicardial hemostatic pad at the apex. The Tendyne prosthesis is retrievable and repositionable after full deployment. Delayed atrial dislocation of Tendyne causing hemolysis and congestive heart failure symptoms has been recently described.1 This condition has occurred in a small number of patients, and there are anecdotal reports of successful retensioning of the apical tether a few weeks after the initial procedure.2 We report a case of late dislocation of a transcatheter mitral prosthesis followed by unsuccessful retensioning and open surgery.