Related Experiment Video
Updated: Jul 4, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transfemoral TAVR in Chronic Type A Aortic Dissection and Severe Aortic Stenosis
María José González-Aguilar1, Guillermo Fernández-García1, Edgar Fuentes-Molina2
1University of Costa Rica, San José, Costa Rica.
Background:
Chronic type A aortic dissection (TAAD) with severe aortic stenosis (AS) represents a major therapeutic challenge, particularly in patients at high surgical risk.
Case Summary:
An 83-year-old woman presented with acute decompensated heart failure (NYHA functional class IV). Imaging revealed severe bicuspid AS and chronic TAAD extending to the infrarenal abdominal aorta. Given the high surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) was performed under transesophageal echocardiography guidance with confirmation of true lumen access, without complications. At 12 months postoperatively, the patient improved to NYHA functional class II with stable dissection.
Discussion:
In selected patients with stable chronic TAAD and no surgical options, TAVR may provide symptomatic benefit when anatomical features are favorable and procedural strategy minimizes aortic wall stress.
Take-Home Message:
TAVR may be feasible in carefully selected patients with chronic TAAD and severe AS when true lumen access is secured and imaging guidance is used to reduce the risk of dissection progression.
