Transcatheter aortic valve implantation for recurrent Valsalva sinus re-dissection and severe aortic regurgitation shortly after surgery for type-A aortic dissection

Delayed aortic regurgitation following Valsalva sinus re-dissection is a well-known complication that can occur at any time after surgery for type-A aortic dissection without root replacement. We describe a case of acute type-A dissection in an 81-year-old lady successfully treated with aortic valve resuspension and ascending aorta replacement with a 28-mm vascular graft. A month later, the patient was readmitted for worsening heart failure and a transthoracic echocardiogram showed severe aortic regurgitation secondary to non-coronary Valsalva sinus re-dissection and non-coronary aortic valve leaflet prolapse also confirmed at computed tomography scan. The patient successfully underwent a transfemoral transcatheter aortic valve implantation with a 29-mm Core Valve Evolut R and concomitant planned extracorporeal membrane oxygenation support.