Carotid TAVR in a patient with pure aortic regurgitation and previous surgery for aortic dissection

• 70 year-old female
• Previous surgery : Aortic dissection in 2005 (supra coronary replacement with a tube of 30mm)
• NYHA III Dyspnea with 3 episodes of acute pulmonary oedema
• TTE: LEF 60%, severe AI with cusp prolaps, LV dilatation and secondary MI grade II and TI grade II
• Left heart cath: Normal
• EuroSCORE I 20,6%; II 6,19%, high risk surgery
• Heart TEAM: off- label TAVR followed by Mitraclip in a second step if needed

• Main arterial acces: Left commun carotid (the only non dissected artery)
• Pigtail from the right arterial artery
• Aortic surface 3,4cm² and perimeter 6,7cm
• Corevalve Pro 26mm with deployement on rapid pacing and TEE guidance

• Discussion in Heart Team and patient jugged at high risk for redo surgery. Endovascular treatment of aortic insufficiency

• Corevalve Pro 26mm

• Not applied in this case

Operators:

• Surgeons: Dr Fabre, Dr Hysi
• Cardiologist: Dr Pécheux, Dr Hannebicque
• Anesthesiologist: Dr Rebet

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