Simultaneous transcatheter aortic valve replacement and thoracic endovascular aortic repair by the transcarotid approach for aortic stenosis with chronic type-A aortic dissection

Abstract

Frail patients presenting with ascending aortic dissection and aortic stenosis (AS) are usually treated with a minimally invasive approach. Although transcatheter aortic valve replacement (TAVR) is becoming the standard treatment for AS, reports of catheter-only treatment for patients with AS complicated by chronic type-A aortic dissection (TAAD) are scarce. We present a case of a patient who underwent simultaneous TAVR and thoracic endovascular aortic repair (TEVAR) using a transcarotid approach. An 86-year-old woman was hospitalized for syncope due to severe AS. Computed tomography revealed chronic TAAD. We considered TAVR appropriate because of the invasive nature of open thoracic surgery; however, TAVR was associated with a risk of chronic TAAD exacerbation due to catheter manipulation. Our heart team decided to simultaneously perform TAVR and TEVAR using the transcarotid approach. The procedure involved using a short stent graft Excluder cuff to cover the dissection entry, followed by the placement of a CoreValve Evolut R 26-mm valve. The operation was successfully completed without complications. The patient was discharged on postoperative day 16. TAVR and TEVAR, using the transcarotid approach, can be performed depending on the anatomic conditions and device selection.

Learning objective

Reports on the catheter-only treatment of severe aortic stenosis complicated by chronic type-A aortic dissection are limited. We herein report a case in which transcatheter aortic valve replacement and thoracic endovascular aortic repair were simultaneously performed. Depending on anatomical conditions, this technique is beneficial, particularly for elderly patients who cannot undergo open thoracic surgery.