Delayed Stanford type A aortic dissection after transcatheter aortic valve implantation with balloon-expandable...

Transcatheter aortic valve implantation is an established treatment for severe aortic stenosis; however, rare complications such as delayed aortic dissection (AAD) can be fatal. We report a 88-year-old woman who developed a Stanford type A AAD 14 days after transcatheter aortic valve implantation with a balloon-expandable valve. Although the patient was initially discharged without complications, she later presented with chest discomfort. A scheduled computed tomography scan incidentally revealed an AAD originating at the sinotubular junction, where the valve frame contacted calcified tissue. Consequently, a surgical repair was performed. In this case, postoperative down-titration of antihypertensive agents and dual antithrombotic therapy (aspirin and edoxaban) may have contributed to the progression of the intramural hematoma and dissection. Although delayed AAD has been predominantly reported in association with self-expanding valves, this case highlights that multiple factors can contribute to AAD with balloon-expandable valves. Therefore, patients with AAD risk factors should be closely monitored.