Advanced Multidisciplinary Management of Severe Aortic Stenosis and Chronic Aortic Dissection With Combined TAVR-TEVAR

Aortic stenosis with concomitant aortic dissection poses unique challenges for transcatheter aortic valve replacement (TAVR). We present such a case in a patient with 29% ejection fraction and a horizontal aorta, in whom combined TAVR and thoracic endovascular aortic repair (TEVAR) was successfully performed. This case highlights the importance of multimodal imaging planning and multidisciplinary discussion in managing complex cardiovascular pathologies. An 82-year-old man with severe aortic stenosis, decompensated heart failure with 29% ejection fraction, multisegmented coronary artery disease (with 5 coronary stents implanted), chronic aortic dissection (Stanford B), and multiple aortic aneurysms underwent successful TAVR and TEVAR via left femoral artery approach with a 29-mm Evolut PRO valve and a thoracic aortic stent (VAMF3636C150TE, Medtronic). Echocardiography performed 3 months post-procedure showed improvement in ejection fraction from preoperative baseline 29% to 42%. This case highlights the feasibility and safety of TAVR in high-risk patients with combined aortic stenosis and atherosclerotic disease, emphasizing the role of advanced imaging and hybrid procedural strategies.