Type A Aortic Dissection After a Transcatheter Aortic Valve Replacement in a Prohibitive Surgical Risk Candidate

Fried, Eric A.; Salter, Benjamin; Weiner, Menachem M.; Faloye, Abimbola; Richter, Ellen; Pineda, Andrés M.

doi:10.1053/j.jvca.2022.04.009

Cited by 1 publication

(1 citation statement)

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“…However, because of the high risk of mortality associated with conversion to open surgery, the decision to proceed to the operating room in such circumstances is based on patient and family preferences and a careful yet timely assessment of risks and benefits by the surgical team. After review of the current literature, many cases of TAVR-associated aortic dissection were ultimately treated non-operatively, either due to patient preference, severity of symptoms, or prohibitive surgical risk [24,[36][37][38]. Some have demonstrated success with a conservative approach to type A dissection following TAVR followed by serial imaging [26,37,39,40].…”

Section: Type a Aortic Dissectionmentioning

confidence: 99%

Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR)

Cavanaugh,

Amirjamshidi,

Hisamoto

2023

JCM

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The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication.

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