Acute Iatrogenic Aortic Root Dissection With Pseudoaneurysm After Transcatheter Aortic Valve Implantation

Major complications of transcatheter aortic valve implantation (TAVI) remain rare but are associated with significant morbidity and mortality. Aortic dissection typically results from procedural trauma to the aorta.

We describe an iatrogenic aortic root dissection and contained aortic laceration during TAVI procedure with a 29-mm Evolut FX in an 88-year-old man with a history of coronary artery bypasses. Postprocedural computed tomography revealed a dissection in the noncoronary sinus of Valsalva with a mediastinal hematoma, evolving into a well defined pseudoaneurysm (20 mm). The patient received conservative management, resulting in a favorable clinical outcome.

This case underscores the importance of preprocedural imaging, precise procedural execution, and close postprocedural monitoring. Although surgical repair is the standard for aortic dissection, conservative management may be an effective alternative in selected high risk patients.