Acute Aortic Dissection after Transcatheter Aortic Valve Replacement

Acute aortic dissection (AAD) is a rare and potentially fatal complication associated with transcatheter aortic valve replacement (TAVR). Due to the paucity of existing institutional data, we sought to assess the incidence of post-implant AAD in patients who underwent TAVR at a single institution. All patients who underwent TAVR from 2013 – 2022 were retrospectively reviewed to identify patients who possessed clinical or radiologic evidence of post-TAVR AAD. Follow-up and survival data were retrieved for all included patients. A total of 4317 patients underwent TAVR, of which 9 (0.2%) sustained an AAD. These patients had a mean age of 80 (range 53 – 92) years, mean STS 30-day mortality risk of 5.7% (2.4-16.7%), and mean effective aortic valve area of 0.8 (0.4-1.5) cm2. Preoperative maximum aortic diameter was 3.9 (2.6-4) cm. Of these 9 patients, 6 (67%) showed evidence of Stanford type A dissection, while 3 (33%) were diagnosed with Stanford type B dissection. The most common causes of dissection were posterior annular rupture by the transcatheter valve (THV) (44%) and THV embolization or “pop-out” into the ascending aorta (22%). A total of six (66.7%) patients, comprised of five (55.6%) type A and one (11.1%) type B aortic dissections, died within 30 days of AAD. The median time to follow-up in those surviving TAVR with intra-operative AAD was 1042 (range: 648-2666) days. Surviving patients were managed via thoracic endovascular aortic repair (TEVAR) and medical management. In conclusion, in this highly selected cohort of patients, our experience demonstrates that AAD following TAVR is a rare, but often lethal, intraprocedural sequelae of THV implantation, especially in cases of type A aortic dissection.