Key result
Emergent transfemoral valve-in-valve TAVR resolves cardiogenic shock in chronic type B dissection.
Why the study?
TAVR is challenging in patients with chronic aortic dissection due to the risk of intraoperative dissection extension, with limited prior case reports.
Does valve-in-valve TAVR safely resolve cardiogenic shock and improve hemodynamics in patients with severe prosthetic aortic valve stenosis and chronic type B aortic dissection?
Case Report (n=1)
No
Does valve-in-valve TAVR safely resolve cardiogenic shock and improve hemodynamics in patients with severe prosthetic aortic valve stenosis and chronic type B aortic dissection?
Transfemoral valve-in-valve TAVR is a feasible and potentially life-saving alternative for managing high-surgical-risk patients presenting with cardiogenic shock, severe aortic stenosis, and chronic type B aortic dissection, provided careful procedural planning and true lumen entry are ensured.
May support emergent valve-in-valve TAVR feasibility in chronic type B dissection with shock; leaves open need for prospective safety data.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a challenge in patients with chronic aortic dissection given risk of intraoperative dissection extension. There are limited prior case reports. CASE SUMMARY: A 45-year-old man with a history of repaired type A dissection and aortic valve replacement with residual type B dissection presented in cardiogenic shock due to severe prosthetic valve stenosis. Because of his surgical risk and rapid decompensation, a valve-in-valve TAVR was successfully performed, followed by resolution of cardiogenic shock. DISCUSSION: We demonstrate a successful valve-in-valve TAVR in a patient with known type B dissection in the setting of hemodynamic deterioration. TAKE-HOME MESSAGES: TAVR is uniquely challenging in patients with type B aortic dissection but is feasible in the acute setting. Femoral access requires special attention to ensure entry into the true lumen.
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Kondapi et al. (2026) conducted a case report in Severe prosthetic aortic valve stenosis with chronic type B aortic dissection and cardiogenic shock (n=1). Valve-in-valve transcatheter aortic valve replacement (TAVR) was evaluated on Resolution of cardiogenic shock and improvement in hemodynamics. Emergent valve-in-valve TAVR was successfully performed via a transfemoral approach in a patient with chronic type B aortic dissection, leading to resolution of cardiogenic shock and recovery of left ventricular ejection fraction to 55%.
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