Acute ascending aortic dissection during transaortic balloon-expandable aortic valve implantation

Transcatheter aortic valve replacement (TAVR) has shown good early and midterm results in high-risk or inoperable patients with severe symptomatic aortic valve stenosis.1 TAVR is generally accomplished with either antegrade transapical or retrograde transfemoral access. If these approaches are not technically possible, transaortic TAVR (Tao-TAVR) is feasible and effective. Tao-TAVR can be performed through either a ministernotomy or a minithoracotomy.2,3 The advantages of Tao-TAVR are mainly related to (1) the short distance between the delivery system and the aortic annulus that enables a precise valve deployment and (2) the possibility to schedule for TAVR patients who have contraindications for the transapical and/or transfemoral approach. Nowadays there is a wide experience with both transapical and transfemoral TAVR, and consequently their related complications are known, predictable, and manageable.4 On the other hand, Tao-TAVR is a relatively new technique that is performed without specifically designed devices, and its possible complications are still not widely known and described. We describe a case of acute ascending aortic dissection during Tao-TAVR that required emergency conversion to open surgery.