Key result
Transapical TAVR may rescue nonsurgical patients with severe AR and chronic type A dissection by avoiding arch manipulation.
Why the study?
Is transapical TAVR feasible and safe in an elderly frail patient with severe native aortic regurgitation and localized chronic type A dissection?
Case Report (n=1)
Is transapical TAVR feasible and safe in an elderly frail patient with severe native aortic regurgitation and localized chronic type A dissection?
Transapical TAVR may represent a feasible mechanism-based rescue strategy for carefully selected nonsurgical patients with severe native aortic regurgitation and localized chronic type A dissection.
May be considered in nonsurgical patients with severe AR and localized chronic type A dissection; extends options but remains hypothesis-generating.
BACKGROUND: Severe native aortic regurgitation complicated by chronic Stanford type A dissection represents an extreme-risk scenario in which surgery may be prohibitive and transfemoral transcatheter aortic valve replacement may increase procedural risk. CASE PRESENTATION: An elderly frail patient with symptomatic severe native aortic regurgitation and localized chronic ascending aortic dissection was deemed unsuitable for surgery. Preprocedural computed tomography demonstrated a short dissection segment above the annulus without sinus or coronary involvement and without imaging features of instability. HOW WE DID IT: To minimize mechanical stress on the dissected ascending aorta, a transapical approach was selected to avoid arch manipulation and enable straight-line coaxial valve delivery. A leaflet-anchoring valve was implanted under fluoroscopic and transesophageal echocardiographic guidance with rapid pacing to ensure controlled deployment. OUTCOME: The procedure was completed without dissection progression or significant paravalvular regurgitation. Follow-up imaging confirmed durable valve function and stable dissection morphology. TAKE-HOME MESSAGE: In carefully selected nonsurgical patients with severe native AR and localized chronic type A dissection, transapical TAVR may represent a mechanism-based rescue strategy by avoiding arch manipulation and enabling controlled valve deployment.
No takes yet. Share an insight, caveat, or question.
Liu et al. (2026) conducted a case report in Severe native aortic regurgitation with chronic Stanford type A dissection (n=1). Transapical transcatheter aortic valve replacement (TAVR) was evaluated on Procedural success (no dissection progression or significant paravalvular regurgitation). Transapical TAVR was successfully performed without dissection progression or significant paravalvular regurgitation in a patient with severe native AR and chronic type A dissection.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: