Transapical TAVR in Native Aortic Regurgitation With Chronic Type A Dissection.

BACKGROUND

Severe native aortic regurgitation complicated by chronic Stanford type A dissection represents an extreme-risk scenario in which surgery may be prohibitive and transfemoral transcatheter aortic valve replacement may increase procedural risk.

CASE PRESENTATION: An elderly frail patient with symptomatic severe native aortic regurgitation and localized chronic ascending aortic dissection was deemed unsuitable for surgery. Preprocedural computed tomography demonstrated a short dissection segment above the annulus without sinus or coronary involvement and without imaging features of instability.

HOW WE DID IT: To minimize mechanical stress on the dissected ascending aorta, a transapical approach was selected to avoid arch manipulation and enable straight-line coaxial valve delivery. A leaflet-anchoring valve was implanted under fluoroscopic and transesophageal echocardiographic guidance with rapid pacing to ensure controlled deployment.

OUTCOME: The procedure was completed without dissection progression or significant paravalvular regurgitation. Follow-up imaging confirmed durable valve function and stable dissection morphology.

TAKE-HOME MESSAGE: In carefully selected nonsurgical patients with severe native AR and localized chronic type A dissection, transapical TAVR may represent a mechanism-based rescue strategy by avoiding arch manipulation and enabling controlled valve deployment.