Acute type A aortic dissection following TAVI

Acute or very early type A aortic dissection (ATAAD) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication requiring emergent cardiac surgery in majority of cases. Beyond reports analyzing the incidence of ATAAD in large registries, there is only scarce data illuminating this complication. Our aim was to analyze its incidence, possible mechanisms, and management in a large two-center cohort.

We performed a retrospective analysis for ATAAD following TAVI in our two-center registry to assess the incidence and outcome, as well as to analyze different causal mechanisms and treatment strategies. 10,238 patients received TAVI between 2008 and 2023. Incidence of ATAAD was 0.15 % (n = 15), of which most occurred periprocedurally. In-hospital mortality was 47 %. Patients with ATAAD were treated with a variety of approaches, 67 % surgically, 27 % interventionally and one patient was treated conservatively solely by blood pressure control. Our results showed no significant associations of ATAAD to the type of prosthetic valves used. Most frequent suspected mechanisms included radial annular stress from balloon or valve expansion (47 %) and catheter- or wire-induced trauma (20 %). Among anatomical risk factors, dilation of the ascending aorta, a horizontal aorta, a small annulus and heavy calcification were frequent contributors.

ATAAD after TAVI, though rare, is a severe complication with a high mortality. Growing procedure volumes and complex anatomies will increase its incidence. Surgeons and interventionalists awareness, pre-procedural planning, institutional readiness, and tailored management pathways are essential to mitigate risk and improve outcomes.