An uncommon complication of a minimally invasive procedure

Decision-making for intervention in symptomatic aortic stenosis should balance the risks of surgery and of transcatheter aortic valve implantation (TAVI). TAVI is a well-established technique for treating elderly and high-risk patients with aortic stenosis using a variety of different surgical approaches (a retrograde transfemoral, transaxillary, transaortic or an antegrade transapical approach). The transapical approach requires the involvement of the heart surgeon and is now limited to cases where the procedure cannot be performed by alternative approaches. We report the case of an 87-year-old patient with severe peripheral arterial disease and a history of TAVI via transapical approach, who presented with a syncopal episode 4 years post-procedure. Imaging revealed a left ventricular apex aneurysm, likely related to the previous transapical TAVI. This case underscores the importance of thorough pre-procedural assessment and long-term follow-up in patients undergoing alternative TAVI access routes, as well as the need for heightened awareness of rare but significant complications such as ventricular pseudoaneurysm. Careful patient selection and individualized procedural planning remain essential to optimize outcomes in this complex population.