A Unique Case of Aortic Dissection 5 Years after TAVR with Evolut Valve
Poster #: 053
Session/Time: B
Author:
Matthew Guy Jackson, BA
Mentor:
Matthew Summers, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Aortic dissection (AD) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication that occurs at an incidence of 0.2-1.0%. Though cases of delayed onset AD have been reported for 5 to 22 months post-procedure, the majority of incidents occur in the peri-procedural or early post-procedural period.
CASE INFORMATION:
A 75-year-old female with a history of ascending aortic aneurysm, atrial fibrillation, hypertension, and heart failure with reduced ejection fraction presented for evaluation of Stanford Type A AD following routine imaging. The patient had an extensive cardiac history including tricuspid regurgitation and mild mitral stenosis following mitral valve repair in 2020 and balloon valvuloplasty in 2024. She had an atrial valve repair in 2005 and a Valve-in-Valve TAVR with implantation of Evolut PRO+ 26 mm stent valve in 2020. An echocardiogram performed 1 year post TAVR demonstrated a well seated valve with a mean gradient of 10 mmHg and no paravalvular leak. A 4.89 cm ascending aortic aneurysm was initially reported on chest CTA in 2020, 1 week prior to the TAVR. This was managed with observation, and subsequent imaging demonstrated an increase to 5.2 cm in 2023. She had another CT in 2025, which revealed aortic dilation to 6.5 cm. At this time, the patient was asymptomatic and exercising daily. She then underwent a CTA that showed a Stanford Type A AD beginning around the distal portion of the TAVR stent, and was admitted to cardiothoracic surgery. Upon admission, she was hemodynamically stable with no chest pain, back pain, orthopnea, or dyspnea. The patient underwent a redo sternotomy with aortic dissection repair with replacement of the aortic root and ascending aorta utilizing a 23 mm KONECT RESILIA aortic valved conduit. Explant of the TAVR valve and surgical aortic valve was performed, as well as mitral valve replacement and tricuspid valve repair. Chest washouts were performed on the subsequent 2 postoperative days. The patient remained admitted for 3 weeks, and was hemodynamically stable, ambulating, and breathing well on room air when discharged home.
DISCUSSION/CLINICAL FINDINGS:
This case is unique because of the extended duration between TAVR and presentation of AD. Delayed onset AD following TAVR is a very rare incident as most occur peri-procedurally or early post-procedurally. Currently, the longest documented delay between TAVR and onset of AD is nearly 2 years. Risk factors for AD include underlying aortic pathologies and mechanical injury from the implantation or valve itself. Our case reports the onset of AD approximately 5 years following TAVR, which is significantly longer than any published literature. During surgical repair, the AD appeared to be subacute versus chronic, with poor aortic tissue quality. The entry tear began at the Evolut valve and the dissection extended to the aortic root.
CONCLUSION:
This case demonstrates the unique presentation of a subacute Stanford Type A AD nearly 5 years after TAVR with Evolut Valve. It is notable as it documents delayed onset AD that is approximately 3 years greater than the longest documented delay in current literature.
Aortic dissection (AD) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication that occurs at an incidence of 0.2-1.0%. Though cases of delayed onset AD have been reported for 5 to 22 months post-procedure, the majority of incidents occur in the peri-procedural or early post-procedural period.
CASE INFORMATION:
A 75-year-old female with a history of ascending aortic aneurysm, atrial fibrillation, hypertension, and heart failure with reduced ejection fraction presented for evaluation of Stanford Type A AD following routine imaging. The patient had an extensive cardiac history including tricuspid regurgitation and mild mitral stenosis following mitral valve repair in 2020 and balloon valvuloplasty in 2024. She had an atrial valve repair in 2005 and a Valve-in-Valve TAVR with implantation of Evolut PRO+ 26 mm stent valve in 2020. An echocardiogram performed 1 year post TAVR demonstrated a well seated valve with a mean gradient of 10 mmHg and no paravalvular leak. A 4.89 cm ascending aortic aneurysm was initially reported on chest CTA in 2020, 1 week prior to the TAVR. This was managed with observation, and subsequent imaging demonstrated an increase to 5.2 cm in 2023. She had another CT in 2025, which revealed aortic dilation to 6.5 cm. At this time, the patient was asymptomatic and exercising daily. She then underwent a CTA that showed a Stanford Type A AD beginning around the distal portion of the TAVR stent, and was admitted to cardiothoracic surgery. Upon admission, she was hemodynamically stable with no chest pain, back pain, orthopnea, or dyspnea. The patient underwent a redo sternotomy with aortic dissection repair with replacement of the aortic root and ascending aorta utilizing a 23 mm KONECT RESILIA aortic valved conduit. Explant of the TAVR valve and surgical aortic valve was performed, as well as mitral valve replacement and tricuspid valve repair. Chest washouts were performed on the subsequent 2 postoperative days. The patient remained admitted for 3 weeks, and was hemodynamically stable, ambulating, and breathing well on room air when discharged home.
DISCUSSION/CLINICAL FINDINGS:
This case is unique because of the extended duration between TAVR and presentation of AD. Delayed onset AD following TAVR is a very rare incident as most occur peri-procedurally or early post-procedurally. Currently, the longest documented delay between TAVR and onset of AD is nearly 2 years. Risk factors for AD include underlying aortic pathologies and mechanical injury from the implantation or valve itself. Our case reports the onset of AD approximately 5 years following TAVR, which is significantly longer than any published literature. During surgical repair, the AD appeared to be subacute versus chronic, with poor aortic tissue quality. The entry tear began at the Evolut valve and the dissection extended to the aortic root.
CONCLUSION:
This case demonstrates the unique presentation of a subacute Stanford Type A AD nearly 5 years after TAVR with Evolut Valve. It is notable as it documents delayed onset AD that is approximately 3 years greater than the longest documented delay in current literature.