Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Aug 16;12(16):5318.
doi: 10.3390/jcm12165318.

Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement

Jan Naar  1 , Dagmar Vondrakova  1 , Andreas Kruger  1 , Marek Janotka  1 , Iva Zemanova  2 , Martin Syrucek  2 , Petr Neuzil  1 , Petr Ostadal  1
Affiliations
Case Reports

Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement

Jan Naar et al. J Clin Med. .

Abstract

Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented in self-expanding, as well as balloon-expandable TAVR valves, manifested primarily as acute aortic syndrome. We present the case of a 76-year-old male, who experienced refractory in-hospital cardiac arrest with non-shockable rhythm due to the obstruction of coronary flow caused by aortic dissection type A, with entry directly adjacent to the aortic prosthesis according to autopsy. The patient died despite the engagement of extracorporeal cardiopulmonary resuscitation. Aortic dissection developed one year after a transfemoral TAVR procedure using an Edwards SAPIEN 3 29 mm self-expanding valve. TAVR-associated late aortic dissection type A represents a rare, life-threatening condition with various clinical manifestations. The risk factors have not been well described and the differential diagnosis may be challenging. As the number of TAVR recipients and their life expectancy is increasing, we may face this complication more often in future.

Keywords: aortic dissection; cardiac arrest; extracorporeal cardiopulmonary resuscitation; transcatheter aortic valve replacement.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have any other potential conflict of interest.

Figures

Figure 1
Figure 1
Standard 12-lead electrocardiogram performed immediately before cardiac arrest (A). Left bundle branch block and atrial fibrillation were known to be chronic as documented on preoperative 12-lead electrocardiogram obtained 2 weeks prior cardiac arrest (B).
Figure 2
Figure 2
Transesophageal echocardiography focused on ascending and descending thoracic aorta performed early (A) and 8 h after cardiac arrest (B).
Figure 3
Figure 3
Autopsy finding of thoracic aorta dissection with an entry closely adjacent to the stainless steel frame of the Edwards SAPIEN 3 TAVR prosthesis.
See this image and copyright information in PMC

References

    1. Carroll J.D., Mack M.J., Vemulapalli S., Herrmann H.C., Gleason T.G., Hanzel G., Deeb G.M., Thourani V.H., Cohen D.J., Desai N., et al. STS-ACC TVT registry of transcatheter aortic valve replacement. J. Am. Coll. Cardiol. 2020;76:2492–2516. doi: 10.1016/j.jacc.2020.09.595. - DOI - PubMed
    1. Hiruma T., Higuchi R., Saji M., Takamisawa I., Shimokawa T., Nanasato M. Transcatheter aortic valve replacement-related aortic dissection: A clinical case series. Catheter. Cardiovasc. Interv. 2023;101:668–675. doi: 10.1002/ccd.30574. - DOI - PubMed
    1. Brinkmann C., Koeppel T., Schofer J. Endovascular entry closure of a late Type A Aortic Dissection after implantation of a self-expanding transcatheter heart valve (Evolut R)—A Case report. Eur. Heart J. Case Rep. 2021;5:ytab343. doi: 10.1093/ehjcr/ytab343. - DOI - PMC - PubMed
    1. Pontious M.E., Ashfaq A., Watson J.J., Song H.K., Fuss C., Chadderdon S.M., Bhamidipati C.M. Late Type A Dissection after Transfemoral Aortic Valve Replacement. JACC Case Rep. 2020;2:877–881. doi: 10.1016/j.jaccas.2019.12.050. - DOI - PMC - PubMed
    1. Buschmann C.T., Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med. 2009;35:397–404. doi: 10.1007/s00134-008-1255-9. - DOI - PubMed

Publication types