Experiences in the Management of Type A Aortic Dissection Following Cardiovascular Interventions: A Case Series Report

Abstract

Background: Cardiovascular interventions such as transcatheter aortic valve replacement (TAVR) and transcatheter edge-to-edge repair (TEER) have become standard options for high-risk patients with valvular heart disease. However, iatrogenic type A aortic dissection (AAD) remains a rare but life-threatening complication, and its optimal management is controversial. Case presentation: We present four patients who developed AAD following cardiovascular interventions at our institution between 2020 and 2024, including three after TAVR and one after TEER. Three patients underwent the Bentall procedure (each requiring removal of the pre-existing transcatheter valve, and one with concomitant coronary artery bypass grafting), and one underwent aortic sinus repair with ascending aorta and total arch replacement using a frozen elephant trunk, together with removal of the previously implanted TEER clip and mitral valve replacement. One patient recovered and was discharged home, another was transferred back to the cardiology department and was discharged home with no sequelae, and two left the hospital against medical advice while still in critical condition, both of whom subsequently died—one 2 days after discharge and the other immediately upon arriving home. Conclusions: Our experience indicates that patients with cardiovascular intervention-related AAD are at particularly high risk owing to pre-existing cardiac dysfunction and deterioration of other organ functions. In such patients, emergency surgical rescue can be life-saving, and the Bentall procedure proved feasible in this selected cohort; however, surgery in this setting is more complex than in routine cases. Careful evaluation, individualized surgical planning, and meticulous perioperative management are essential to improve outcomes.