Combined surgical and catheter‐based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

Abstract

An extensive thoracic aortic aneurysm (TAA) is a potentially life‐threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter‐based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR. © 2014 Wiley Periodicals, Inc.

Transcatheter Aortic Valve Implantation as a Bailout Procedure for Acute Aortic Valve Regurgitation During Endovascular Arch Repair

“…Transaortic valve implantation (TAVI) has rapidly improved in the past few years and is now routinely used to treat symptomatic aortic valve stenosis in patients deemed at high risk from conventional surgery, 2,3 even in conjunction with thoracic endovascular aortic repair. 4 TAVI remains controversial for the treatment of patients with native aortic valve regurgitation, mostly because the size of the aortic annulus and the low degree of calcification in those patients can compromise stable fixation of the valve. However, reports of patients successfully treated with TAVI for degenerative bioprosthetic devices 5,6 or severe native aortic valve regurgitation 7 have been published.…”

Commentary: Emergent TAVR During TEVAR

“…Elective TAVR combined with TEVAR has been reported in a few patients with successful outcome. 21–25 TAVR has also been used electively to treat pure severe native aortic valve regurgitation, albeit in a much smaller number of patients compared to those with aortic stenosis. 26,27 However, absence of aortic valve calcification, which is common with pure native aortic valve regurgitation, may compromise fixation of the implanted valve frame to the aortic annulus, leading to malpositioning and need for implantation of a second valve.…”