Successful Simultaneous Transfemoral Aortic Valve Implantation and Thoracic Endovascular Aortic Repair for Severe Aortic Valve Stenosis and a Large Dissecting Thoracic Aortic Aneurysm

Abstract

Objective: A few cases of simultaneous transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) have been reported; however, simultaneous TAVI and thoracic EVAR (TEVAR) are rare. We aimed to report the successful treatment of a case of severe aortic valve stenosis (AS) concomitant with a giant thoracic aortic aneurysm (TAA), in which TEVAR preceded TAVI.

Case Presentation: An 81-year-old patient was referred to our hospital for the treatment of severe AS and a large dissecting TAA. The TAA abruptly enlarged in a short time and showed plaque-rich atheroma; therefore, passing the TAVI device through the TAA was a concern. Moreover, hemodynamic instability because of severe AS during TEVAR under general anesthesia was a concern. After discussion with the multidisciplinary team, we planned simultaneous surgery with TAVI after TEVAR in this case. Before surgery, extracorporeal membrane oxygenation (ECMO) support was prepared via the left femoral artery and vein, and TEVAR was performed through the right femoral artery. TAVI was performed after the sheath was changed. Although passing the TAVI device through the stent graft was slightly difficult, it was possible with guidewire control.

Conclusion: TAVI was successfully performed after TEVAR in a patient with severe AS and a giant thoracic aneurysm. We were able to prevent critical aortic-related events because TEVAR was performed beforehand.