Key result
Simultaneous transfemoral ViV-TAVR and debranching TEVAR proves feasible in high-risk aortic disease.
Why the study?
Complex vascular access conditions such as aortic aneurysm, severe tortuosity, and shaggy aorta pose challenges for transfemoral TAVR procedures.
Case Report (n=1)
No
This case demonstrates the feasibility of single-stage transfemoral valve-in-valve TAVR and TEVAR in a high-risk patient with multicomponent disease.
May offer feasible alternative access for complex TAVR; leaves open need for prospective studies before wider adoption.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a viable treatment option for managing aortic prosthetic valve dysfunction. Although the transfemoral approach is the most commonly used and preferred treatment strategy for TAVR, complex vascular access, such as aortic aneurysm, severe tortuosity, and shaggy aorta, is challenging. CASE SUMMARY: An 87-year-old man, who underwent surgical aortic valve replacement for aortic stenosis using a 21-mm Carpentier-Edwards Perimount Valve, presented with New York Heart Association functional Class III dyspnoea. He was diagnosed as having severe symptomatic structural valve deterioration of a bioprosthetic aortic valve. Computed tomography revealed a tortuous and shaggy descending aorta with a saccular aneurysm in the aortic arch. Simultaneous transfemoral valve-in-valve TAVR and Zone 2 thoracic endovascular aortic repair (TEVAR) with debranching were successfully performed using a 22-Fr 65-cm sheath. Although the patient developed paraplegia due to transient spinal cord ischaemia associated with TEVAR, he fully recovered with vasopressor therapy. DISCUSSION: To the best of our knowledge, this is the first report on simultaneous successful 'valve-in-valve' TAVR and debranching TEVAR using the transfemoral approach. This case demonstrated the feasibility of single-stage transfemoral TAVR and TEVAR in a high-risk patient with multicomponent disease.
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Kadoya et al. (2020) conducted a case report in Severe symptomatic structural valve deterioration of a bioprosthetic aortic valve and aortic arch saccular aneurysm (n=1). Simultaneous transfemoral valve-in-valve TAVR and Zone 2 TEVAR with debranching was evaluated on Procedural success and feasibility. Simultaneous transfemoral valve-in-valve TAVR and debranching TEVAR was successfully performed in an 87-year-old man, demonstrating the feasibility of this single-stage approach in high-risk patients.
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