Simultaneous transfemoral valve-in-valve transcatheter aortic valve replacement and debranching thoracic endovascular aortic repair through a tortuous and shaggy aorta: A case report

Abstract

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.