Transcatheter Aortic Valve Implantation in Complex Aortic Pathology: Managing Aortic Regurgitation With Chronic Dissection and Previous Endovascular Repair.

Transcatheter aortic valve implantation (TAVI) is generally contraindicated in patients with severe aortic regurgitation associated with anatomically complex scenarios such as prior aortic dissection and/or aortic graft replacement. However, it may be considered in selected patients following heart team evaluation and optimal procedure planning. We report the case of an 81-year-old man with severe aortic regurgitation (AR) who had previously undergone ascending aorta replacement and aorto-bisiliac endovascular aneurysm repair (EVAR) in two consecutive procedures, due to an acute aortic dissection extending from the sinotubular junction to the iliac bifurcation. This case highlights the feasibility and efficacy of TAVI in anatomically extreme post-dissection scenarios, underscoring the importance of individualized decision-making and detailed pre-procedural planning.