Valve-in-valve-prosthesis embolization and aortic dissection: Single procedure, double complication

Michal Szlapka*, Eriberto Michel, Mark J. Ricciardi, S. Christopher Malaisrie

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Transcatheter aortic valve implantation (TAVI) is a recognized treatment method for high-risk patients with aortic stenosis. TAVI is also recommended for structural valve degeneration of a biological valve prosthesis. TAVI-specific complications, such as prosthesis embolization and aortic dissection, are uncommon but potential concerns. A 73-year-old woman presented with structural valve degeneration 14 years after aortic root replacement with a bioprosthetic valved conduit. The patient underwent TAVI valve-in-valve under monitored anaesthesia care. Intraoperatively, the self-expandable prosthesis was difficult to deploy within the valved conduit and ultimately migrated distally. During the technically difficult passage of the prosthesis delivery system through the tortuous aorta, the patient started reporting symptoms suggestive of aortic dissection. An emergency computed tomography scan confirmed type B dissection. Thoracic endovascular aortic repair followed by deployment of a balloon-expandable prosthesis below the self-expandable implant was performed. Careful prosthesis selection in valve-in-valve patients after aortic root replacement is crucial for procedural success.

Original languageEnglish (US)
Pages (from-to)204-205
Number of pages2
JournalEuropean Journal of Cardio-thoracic Surgery
Volume56
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • Aortic dissection
  • Aortic valve stenosis
  • Prosthesis embolization
  • Structural valve degeneration
  • Thoracic endovascular aortic repair
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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