Simultaneous Transcatheter Aortic Valve Implantation and Infrarenal Aortic Aneurysm Repair for Severe Aortic Stenosis and Abdominal Aortic Aneurysm: Report of 2 Cases and Literature Review

Abstract

<jats:p> The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential. </jats:p>

Current issues on simultaneous TAVR (Transcatheter Aortic Valve Replacement) and EVAR (Endovascular Aneurysm Repair)

“…The supporters of the notion that TAVR should be first, highlighted that hemodynamic stability is the major concern in these critically ill patients. In addition to this, the TAVR‐first strategy reduces the risk of local thrombosis, as the larger catheters remain less time in place, and other intraoperative complications such as migration of the stent graft that was placed through EVAR or aneurysm rupture due to TAVR manipulations 12 …”

“…On the other hand, those who prefer the EVAR‐first strategy signify that the risk of AAA rupture, aortic dissection, and peripheral embolism is higher when the aortic valve replacement is preceded 10 . According to this point of view, the possibility of vascular injury is lower when EVAR is deployed first as the abdominal stent graft acts like a inner coverage of the aorta eliminating the possibilities of damages due to TAVR device manipulations 12 . Currently, the decision is based mainly on the preference of the members of the team.…”

“…10 According to this point of view, the possibility of vascular injury is lower when EVAR is deployed first as the abdominal stent graft acts like a inner coverage of the aorta eliminating the possibilities of damages due to TAVR device manipulations. 12 Currently, the decision is based mainly on the preference of the members of the team.…”

“…In addition to this, the TAVR-first strategy reduces the risk of local thrombosis, as the larger catheters remain less time in place, and other intraoperative complications such as migration of the stent graft that was placed through EVAR or aneurysm rupture due to TAVR manipulations. 12 In our case, this strategy was chosen after evaluating the patient's clinical status and estimating the risk of hemodynamic collapse.…”

Combined Triple Transcatheter Aortic Procedure in a Patient With Aortic Stenosis, Coarctation, and Aneurysm

“…Stepwise procedures have been used in the past, and earlier successful reports of combined intervention were available for a patient undergoing simultaneous treatment of AS and aortic aneurysm, but not the 3 conditions ( 3 ). The complexity of risk assessment was increased because it was difficult to predict the hemodynamic impact of TAVR on the other two conditions.…”