Key result
Endovascular closure of the entry to the false lumen using an Amplatzer Cribriform Septal Occluder successfully reduced maximal aortic diameter from 62 to 55 mm in a patient with late TAAD after TAVI.
Why the study?
Late Stanford type A aortic dissections are a very rare complication after TAVI, and while surgery is the treatment of choice, perioperative mortality and neurological complications remain high.
Case Report (n=1)
Endovascular closure of the entry to the false lumen using a septal occluder can be a successful alternative for late type A aortic dissection after TAVI in patients at extreme surgical risk.
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.
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Brinkmann et al. (2021) conducted a case report in Late Stanford type A aortic dissection after TAVI (n=1). Endovascular closure using a 25 mm Amplatzer Cribriform Septal Occluder was evaluated on Maximal aortic diameter reduction and false lumen thrombosis. Endovascular closure of the entry to the false lumen using an Amplatzer Cribriform Septal Occluder successfully reduced maximal aortic diameter from 62 to 55 mm in a patient with late TAAD after TAVI.
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