CONGRESS ABSTRACT

The rapid expansion of TAVR higlights its effectiveness and acceptance as a viable treatment option for severe aortic valve disease. Understanding the evolving indications of TAVR is crucial for optimizing patient selection and ensuring appropriate utilization. Despite TAVR has a well-established record of excellent outcomes, cardiovascular events and complications remain relatively common, occasionally life-threatening, requiring emergency interventions with increased technical complexity and impaired outcomes. This report presents a rare TAVR-related complication: development of a pseudoaneurysm in the distal aortic arch. A 76‐year‐old female patient treated with TAVR (Evolut Pro Plus 26) for severe symptomatic aortic stenosis, discharged at home after an uneventful recovery, presented at the emergency department on seventh post-procedural day with progressive chest and periscapular back-pain and dyspnea (New York Heart Association-III). An acute coronary syndrome was ruled out. Cardiac multi-detector computed tomography (CT) revealed a large pseudoaneurysm of the distal aortic arch, just downstream the left subclavian artery’s emergence. (Fig 1). It is noteworthy that a CT performed before the first TAVR (TAVR1), had documented the presence of an aortic calcific plaque where the pseudoaneurysm later formed (Fig 2). The intraoperative TAVR1 angiogram had documented a good result, therefore, we hypothesize the development of the pseudoaneurysm post-TAVR1. After multidisciplinary consultation she underwent a hybrid approach with thoracic endovascular prothesis implantation with landing zone immediately downstream the origin of the left common carotid artery and a concomitant left carotid-subclavian bypass. An angio-CT performed two months later documented correct position of the endoprosthesis, regular opacification of the aorta and patency of the supra-aortic vessels (Fig 3). As TAVR procedures become more widespread, there is a pressing need for a comprehensive understanding of the associated complications. Beyond the well-documented procedural risks including vascular injury and paravalvular leak, attention must be paid to the unexperienced emerging complications. This case report underscores the importance of an effective post-operative monitoring and a prompt evaluation of new onset of symptoms, as well as the critical role of multidisciplinary collaboration in managing complex cardiovascular conditions following interventional procedures.