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As reported by the field clinical specialist, during a right transfemoral transcatheter aortic valve replacement procedure to implant a 26 mm sapien 3 ultra resilia valve (s3ur), there was difficulty advancing the valve through the 14f esheath+ and the valve had a bent strut.It was noted that the right side access vessels were calcified and tortuous.There was slight difficulty inserting the esheath+ into the patient due to tortuosity.The esheath+ was not inserted at a steep angle.The vessel was dilated with a 16f kit dilator and the 14f esheath+ and dilator were inserted through.The esheath+ was also expanded with the 16f dilator.High push forces were experienced near the iliac, when the system was in the fully expandable portion of the esheath+.The operator was able to slide the esheath+ back slightly away from the tortuosity and then advance the valve through.It was noted that the s3ur valve had one inflow strut bent backwards.The s3ur valve was deployed with nominal volume.The strut remained in the bent position after deployment.A contrast runoff shot was taken to verify there were no injuries in the right iliac.The patient was in stable condition.Upon removal of the devices, it was noted that there was an elongated white scrape line in the blue portion of the esheath+.Per report, the bent strut were attributed to the s3ur valve hitting a difficult turn in the esheath+ while advancing the commander delivery system with sapien 3 ultra resilia valve.
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