Transapical TAVR in Native Aortic Regurgitation With Chronic Type A Dissection

Severe native aortic regurgitation complicated by chronic Stanford type A dissection represents an extreme-risk scenario in which surgery may be prohibitive and transfemoral transcatheter aortic valve replacement may increase procedural risk.

An elderly frail patient with symptomatic severe native aortic regurgitation and localized chronic ascending aortic dissection was deemed unsuitable for surgery. Preprocedural computed tomography demonstrated a short dissection segment above the annulus without sinus or coronary involvement and without imaging features of instability.

To minimize mechanical stress on the dissected ascending aorta, a transapical approach was selected to avoid arch manipulation and enable straight-line coaxial valve delivery. A leaflet-anchoring valve was implanted under fluoroscopic and transesophageal echocardiographic guidance with rapid pacing to ensure controlled deployment.

The procedure was completed without dissection progression or significant paravalvular regurgitation. Follow-up imaging confirmed durable valve function and stable dissection morphology.

In carefully selected nonsurgical patients with severe native AR and localized chronic type A dissection, transapical TAVR may represent a mechanism-based rescue strategy by avoiding arch manipulation and enabling controlled valve deployment.