Iatrogenic dissection of the descending aorta: Conservative or endovascular treatment?

Abstract

Transcatheter aortic valve implantation (TAVI) is without any doubt a standard technique and the treatment of choice of severe aortic valve stenosis (AVS) in very high-operative risk patients. However, a number of complications may occur and has been described. Improper valve position, valve migration, paravalvular regurgitation, conduction disturbances, stroke and aortic dissection have been succeeded despite the perfection of the technique. For anyone of the complications above described, a solution may be invented. We present an interesting case of an 81-year-old woman with severe AVS treated through TAVI due to very high operative risk. This female, 12 days later presented with thoracic pain and shortness of breath and through the computed tomography of the chest performed was diagnosed a dissection of the descending aorta. She successfully underwent on thoracic endovascular aortic repair. In this report, we refer the bibliographic data and we discuss the treatment options in these cases.

Rapid development of an iatrogenic aortic dissection following transcatheter aortic valve implantation

“…Several case reports on IAD following TAVI have been published in which the dissection occurred either during the procedure [ 15 , 16 ] or several days or even years later [ 17 – 20 ]. In those delayed cases, there was either endocarditis of the prosthetic valve or the dissection was located at the aortic annulus, the aortic root, or the valve cage area [ 17 – 19 , 21 ].…”

Spontaneous Resolution of Extensive Iatrogenic Type A Aortic Dissection After Transcatheter Aortic Valve Replacement

“… 3 , 4 Endovascular therapy had a remarkable outcome in several cases, but its application was limited to type B AD. 5 Few patients had recovered with medical treatment; as in our case, 6 , 7 they were in hemodynamically stable condition and had no pericardial effusion or branch vessel compromise. However, we did not find any cases presenting the natural course of extensive TAAD immediately after TAVR with complete serial imaging data, and the mechanism of spontaneous resolution remains unclear.…”

Transcatheter aortic valve replacement‐related aortic dissection: A clinical case series

“…Even in uncomplicated type B AD cases, selected patients require preemptive TEVAR within 1 year after onset 22 . In TAVR‐related type B AD cases, both TEVAR and medical treatment reportedly resulted in favorable clinical outcomes 6,23,24 . An autopsy case in which AD was not diagnosed in a timely manner and ruptured was also reported 25 .…”

“…All patients (100%) were conservatively treated with strict blood pressure control (target systolic blood pressure < 120 mmHg, heart rate < 60 beats per min), pain control, and sedation if needed. All patients (100%) survived until discharge on postoperative day 30 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) 3.4 | Type B AD (Tables 1 and 2, Figures 1 and 2)…”