Time	Events
0 min	Valve-in-valve transcatheter aortic valve implantation started under general anaesthesia under transoesophageal echocardiogram (TOE) guidance.
60 min	Nosecone advanced across the bioprosthetic valve. Patient became hypotensive. TOE showed a large mobile echogenic mass that appeared to be moving back and forth from the left ventricle to the aorta through the annulus.
70 min	No pericardial effusion was noted on TOE. Severe intra-valvular regurgitation was noted. No response was observed to intravenous vasopressors, inotropes, and rapid ventricular pacing to improve haemodynamic stability. The large mobile mass was no longer seen. Evolut R valve deployment.
90 min	Absence of distal left lower extremity pulses was noted. Angiography showed a large filling defect at the level of the left common femoral artery bifurcation.
180 min	Open exploration of the femoral artery and embolectomy was performed. Leaflet of previous bioprosthetic valve was removed. Left lower extremity circulation was re-established.