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Brinkmann C, Koeppel T, Schofer J. Endovascular entry closure of a late type A aortic dissection after implantation of a self-expanding transcatheter heart valve (Evolut R): a case report. Eur Heart J Case Rep. 2021;5(9):ytab343doi: 10.1093/ehjcr/ytab343.
Brinkmann, C., Koeppel, T., & Schofer, J. (2021). Endovascular entry closure of a late type A aortic dissection after implantation of a self-expanding transcatheter heart valve (Evolut R): a case report. European heart journal. Case reports, 5(9), ytab343. https://doi.org/10.1093/ehjcr/ytab343
Brinkmann, Christina, et al. "Endovascular entry closure of a late type A aortic dissection after implantation of a self-expanding transcatheter heart valve (Evolut R): a case report." European heart journal. Case reports vol. 5,9 (2021): ytab343. doi: https://doi.org/10.1093/ehjcr/ytab343
Brinkmann C, Koeppel T, Schofer J. Endovascular entry closure of a late type A aortic dissection after implantation of a self-expanding transcatheter heart valve (Evolut R): a case report. Eur Heart J Case Rep. 2021 Aug 18;5(9):ytab343. doi: 10.1093/ehjcr/ytab343. eCollection 2021 Sep. PMID: 34557637; PMCID: PMC8453414.
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Eur Heart J Case Rep. 2021 Aug 18;5(9):ytab343. doi: 10.1093/ehjcr/ytab343. eCollection 2021 Sep.

Endovascular entry closure of a late type A aortic dissection after implantation of a self-expanding transcatheter heart valve (Evolut R): a case report.

European heart journal. Case reports

Christina Brinkmann, Thomas Koeppel, Joachim Schofer

Affiliations

  1. MVZ-Department Structural Heart Disease, Asklepios Clinic St. Georg, Lohmühlenstraße 520099 Hamburg, Germany.
  2. Department for Vascular Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.

PMID: 34557637 PMCID: PMC8453414 DOI: 10.1093/ehjcr/ytab343

Abstract

BACKGROUND: Late Stanford type A aortic dissections (TAADs) are a very rare complication after transcatheter aortic valve implantation (TAVI). Surgery is the treatment of choice, but perioperative mortality (25%) and neurological complications (18%) remain high.

CASE SUMMARY: An 85-year-old male patient presented with acute chest pain 5 months after a transfemoral Evolut R 34 mm transcatheter heart valve (THV) implantation. On multi-slice computed tomography (MSCT) a TAAD was found with a 7 mm primary entry at the supra-annular aortic edge of the THV expanding to the innominate artery without re-entry. Due to extensive comorbidities including two bypass operations in the history, the Heart Team declined surgery. Within 6 months of watchful waiting the maximal aortic diameter (MAD) increased from 57 to 62 mm. The decision was made to perform an endovascular closure of the inflow to the false lumen by implanting a 25 mm Amplatzer™ Cribriform Septal Occluder. MSCT 4 weeks after occlusion showed the false lumen almost completely filled with thrombus, MSCT 3 months later showed a MAD reduction to 55 mm with shrinkage of the false lumen.

DISCUSSION: Presumably, the late TAAD was caused by the supra-annular edge of the Evolut-stent. Because of the extreme risk surgical repair was not an option and a stent graft would have occluded the vein grafts. This case shows that in absence of any other treatment options endovascular closure of the entry to the false lumen can be successfully performed in a TAAD after TAVI.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords: Case report; Self-expanding transcatheter heart valve; Stanford type A aortic dissection; TAVI

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