A Rare Case of Post-transcatheter Aortic Valve Implantation Complicated by Aortic Dissection and a Preoperative Anaphylactic Reaction.

Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. Despite its minimally invasive nature, serious complications can occur, particularly in frail, elderly individuals. An 89-year-old, frail woman with severe symptomatic aortic stenosis and multiple comorbidities underwent elective TAVI. The procedure, planned under conscious sedation, was complicated by an anaphylactic reaction to an antibiotic, requiring emergency intubation, vasopressor support, and intensive care admission. TAVI was subsequently completed successfully. Postoperatively, she developed sudden chest and back pain, new-onset atrial fibrillation with hemodynamic instability, and a reduced level of consciousness. Transesophageal echocardiography revealed a thoracic aortic dissection (AD). Given her advanced age, frailty, and poor surgical candidacy, no further intervention was pursued. Despite maximal supportive therapy, she deteriorated and passed away peacefully. This case highlights the challenges of managing frail, elderly patients undergoing TAVI. Although the procedure offers a less invasive alternative to surgery, severe complications such as AD may occur. Individualized risk assessment, multidisciplinary evaluation, and alignment of treatment goals are essential for optimal care.