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Transcarotid Transcatheter Aortic Valve Replacement in an Octogenarian With Complex Type B Aortic Dissection and

Kae-Woei Liang1,2, Chu-Leng Yu1,3, Wei-Wen Lin1,4,5

  • 1Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.

CJC Open
|October 29, 2021
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) via the carotid artery is safe for patients with severe aortic stenosis and complex aortic dissection. Three-dimensional echocardiography aids device sizing in chronic kidney disease.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Nephrology

Background:

  • Severe aortic valve stenosis (AS) and chronic kidney disease (CKD) pose challenges for transcatheter aortic valve replacement (TAVR).
  • Complex aortic dissection, particularly type B, complicates TAVR procedures.
  • Accurate device sizing is critical for TAVR success, especially in patients with impaired renal function.

Observation:

  • An octogenarian patient presented with severe AS, heart failure, and advanced CKD.
  • Noncontrast computed tomography revealed complex aortic dissection involving the aortic arch, descending thoracic aorta, and abdominal aorta.
  • A 3-dimensional transesophageal echocardiogram was utilized for precise device sizing due to CKD.

Findings:

  • Transcatheter aortic valve replacement (TAVR) was successfully performed using a transcarotid approach with a CoreValve device.
  • The procedure resulted in no cerebral vascular events.
  • Renal function was well preserved post-TAVR.
  • The patient's complex type B aortic dissection did not preclude a safe TAVR outcome.

Implications:

  • Transcarotid TAVR is a viable and safe option for patients with severe AS and complex type B aortic dissection.
  • Three-dimensional transesophageal echocardiography offers a reliable alternative for device sizing in patients with advanced CKD undergoing TAVR.
  • This case highlights the successful management of complex cardiovascular and renal comorbidities during TAVR.

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