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

Shaelyn Cavanaugh1, Hossein Amirjamshidi1, Kazuhiro Hisamoto1

  • 1Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.

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Summary

Transcatheter aortic valve replacement (TAVR) is a safe alternative to surgery. However, rare but serious complications like type A aortic dissection can occur, requiring prompt recognition and multidisciplinary management for successful outcomes.

Keywords:
TAVRiatrogenic aortic dissectiontype A dissection

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Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Transcatheter aortic valve replacement (TAVR) has become a standard treatment for aortic stenosis.
  • Improvements in TAVR technology and techniques have reduced complication rates.
  • Potential risks, including life-threatening aortic injuries, necessitate vigilant monitoring and management strategies.

Purpose of the Study:

  • To review catastrophic iatrogenic aortic injuries associated with TAVR.
  • To present a case of acute iatrogenic type A aortic dissection during TAVR.
  • To highlight the importance of prompt recognition and multidisciplinary management of procedural complications.

Main Methods:

  • Literature review of iatrogenic aortic injuries during TAVR.
  • Case report detailing a patient who developed type A aortic dissection post-TAVR.
  • Description of diagnostic and therapeutic interventions, including urgent imaging and surgical repair.

Main Results:

  • The case illustrates a rare but severe complication: type A aortic dissection following TAVR.
  • Neurologic deficits were the presenting signs of the aortic dissection.
  • Successful surgical repair was achieved through prompt diagnosis and intervention.

Conclusions:

  • TAVR is a valuable procedure, but awareness of potential catastrophic complications like aortic dissection is crucial.
  • Early detection of neurologic changes post-TAVR can indicate serious aortic injury.
  • Multidisciplinary team coordination is vital for timely and effective management of life-threatening procedural complications.