Type A aortic dissection is a cardiovascular emergency. Its incidence seems to have increased in the last few years; it is not clear whether this is a consequence of the ageing population or better awareness of the diagnosis (1). Acute type A aortic dissection is often lethal without urgent surgical treatment with mortality rates of around 17% (2). Pheochromocytomas are rare tumors, though often asymptomatic, they could be lethal if left untreated. The incidence is around 0.6 per 100,000 persons per year (3). The association of both aortic dissection and pheochromocytoma is rare. Here, we report a case of a 36-year old patient with pheochromocytoma and hypertension, whose delay of surgery due to the Covid-19 pandemic led to acute type A aortic dissection.

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Background Despite the gold-standard approach for transaortic valve implantation (TAVI) remains transfemoral (TF), alternative approaches are needed in patients who present contraindications to transfemoral access. Case summary We report the case of a 79-year-old female with a symptomatic high gradient severe aortic stenosis - mean gradient of 43 mmHg- and a significant supra-aortic trunk stenosis (left carotid artery: 90-99%; right carotid artery: 50-70 %), and who was hospitalized for progressive dyspnea New York Heart Association (NYHA) stage III. In this high-risk patient, it was decided to perform a transaortic valve implantation (TAVI). Because of a history of stenting of both common iliac arteries in a context of an arterial insufficiency of the lower limbs (Leriche classification stage III) and stenotic thoraco-abdominal aorta atheromatosis, an alternative approach to the transfemoral transaortic valve implantation (TF-TAVI) one was needed. It was decided to perform a combined Transcarotid-TAVI (TC-TAVI) with EDWARDS S3 23 mm valve with a left endarteriectomy during the same operating time. Discussion Our case illustrates an alternative approach to perform a percutaneous aortic valve implantation, despite supra-aortic trunk stenosis, in a high risk surgical patient contraindicated to a TF-TAVI. TC-TAVI remains a safe alternative when transfemoral-TAVI is contraindicated, and the combined approach of CEA and TC-TAVI offers a minimally invasive one-step treatment in high operative risk patients.