Repair of iatrogenic type A dissection following trans-catheter aortic valve replacement: Case Presentation

P0284 

Abstract Submission 

Krishna Mani (1), Alexander Smith (2), Adnan Charaf (2), David Smith (2), Marjan Jahangiri (3)

(1) St George's, University of London, United Kingdom, (2) St George's, University of London, London, NA, (3) St. George's Hospital and University of London, London, United Kingdom

Krishna Mani    -  Contact Me
St George's, University of London

Alexander Smith    -  Contact Me
St George's, University of London

Adnan Charaf    -  Contact Me
St George's, University of London

David Smith    -  Contact Me
St George's, University of London

*Marjan Jahangiri    -  Contact Me
St. George's Hospital and University of London

Krishna Mani    -  Contact Me
N/A

Repair of iatrogenic type A dissection following trans-catheter aortic valve replacement: Case Presentation
Krishna Mani, Alexander Smith, Adnan Charaf, David Smith, Marjan Jahangiri

Objective: Transcatheter aortic valve replacement (TAVR) has been established as an effective treatment for patients with severe aortic stenosis (AS) in patients with high and intermediate operative risk for surgical aortic valve replacement. Complications associated with this procedure, including aortic dissection, is rare. We present a case of an emergency repair of a type A aortic dissection following TAVR.

Case Video Summary: An 81-year-old woman presented with dyspnea, fatigue, and paroxysmal nocturnal dyspnea. She had a past medical history of a liver transplant 30 years prior. Her echocardiography revealed severe AS with a normal ejection fraction. Her coronary angiogram was normal. She underwent an elective TAVR which was complicated by femoral artery stent, drainage of a hemopericardium and an iatrogenic type A aortic dissection, which was detected 10 days later. She underwent an emergency repair of iatrogenic acute type A aortic dissection with TAVR explantation, tissue aortic valve replacement with a 21mm Magna Ease valve, and replacement of ascending aorta using a 28mm hemoshield vascular graft. Her operation was complicated by spontaneous rupture of the ascending aorta and changes in standard myocardial arrest and protection strategies, from antegrade to retrograde cardioplegia due to the TAVR struts. She had a prolonged intensive care unit stay requiring medical management with vasoconstrictors and inotropes. She was subsequently transferred to her local hospital for further rehabilitation.

Conclusions: We describe successful repair of an acute ascending aortic dissection following TAVR. It highlights the technical considerations for these patients, including possible damage to the aortic root and anterior mitral valve leaflet during explantation, spontaneous aortic rupture, and cardioplegia strategies.

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