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It was reported by the field clinical specialist (fcs), that during a transfemoral transcatheter aortic valve replacement (tavr) procedure with a 26 mm sapien 3 ultra resilia (s3ur) valve, there was difficulty advancing the delivery system through the esheath+.The right access vessels were calcified and were narrowing in the tortuosity bend region; high force pushes were experienced near the iliac.The physician was able to slide the esheath+ backwards, slightly away from the tortuosity, and then advance the valve through the end of the system.During exit of the valve through the esheath, one of the inflow struts was bent backwards.The decision was made to continue with valve implantation and the 26 mm s3ur was deployed with nominal volume.After valve deployment, delivery system was withdrawn through sheath.Upon esheath+ removal, a liner tear was noted.To verify that there were no injuries to the right iliac during the procedure, a contrast runoff shot was taken and confirmed no patient injury.At the end of the procedure, the patient was in stable condition.The perceived root cause reported was that the right access vessel was calcified and narrowed into a tortuous bend region, which contributed to resistance during advancement and the subsequent device damage.
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