A new case report demonstrates the rare instance of a type A aortic dissection spontaneously sealing after transcatheter heart valve deployment, allowing for successful conservative management in a high-risk patient. The report, published online and in the upcoming issue of JACC: Case Reports, details an unusual case of acute type A aortic dissection (TAAD) during TAVR that was successfully managed without surgical intervention. Led by Lianyue Ma, MD, from the Department of Cardiology at Qilu Hospital of Shandong University, China, the team described a rare but life-threatening complication of TAVR with an unexpected favorable outcome. "Acute aortic dissection, although rare, is a life-threatening complication associated with TAVR," the authors wrote. "In the case we report, the dissection spontaneously sealed after prosthetic valve placement, thereby avoiding emergency surgery." Study Details The case involved an 82-year-old man with severe aortic stenosis who was admitted for worsening dyspnea, chest discomfort, and syncopal episodes. His medical history included coronary disease, hypertension, and pulmonary embolism. Echocardiography confirmed severe aortic stenosis with a mean pressure gradient of 68 mm Hg and peak velocity of 5.12 m/s. Given his high surgical risk (STS PROM score of 12%), the team opted for TAVR. During the procedure, a 29-mm Venus A-Plus transcatheter heart valve was selected. During initial valve release, the device unexpectedly moved upward into the aorta, necessitating retrieval under rapid pacing. The second attempt achieved optimal valve deployment, but post-deployment arteriography revealed a localized dissection of the ascending aortic root extending to the valve crown. Transesophageal echocardiography confirmed TAAD without pericardial effusion or coronary ostia involvement. Despite the TAAD, the patient remained hemodynamically stable with no extension of the dissection on angiography. After multidisciplinary consultation, the team chose conservative management rather than immediate surgery. They proposed that the bioprosthetic valve compressed the entry portion of the dissection, reducing the risk of extension. This mechanical sealing effect allowed for safe implementation of conservative management in a patient who would have faced significant surgical risks. Follow-up CT angiography at 3 days, 30 days and 6 months post-procedure showed no progression of the dissection, and the patient recovered uneventfully with improved exercise tolerance at 6 months. "Although urgent surgery remains the gold standard to mitigate early mortality, this case demonstrates that select high-risk patients with hemodynamic stability may benefit from nonsurgical approaches," the researchers noted. "Spontaneous sealing of the dissection entry by the transcatheter heart valve underscores the potential for device-based solutions to stabilize anterograde TAAD, circumventing the morbidity of surgery in frail patients," they added. The authors emphasized that multidisciplinary consensus is critical in these cases, integrating input from interventional cardiologists, cardiac surgeons and radiologists. They highlighted the importance of serial imaging and hemodynamic monitoring to detect any dissection progression and ensure that conservative management remains safe. Source: Ma L, Liang Y, Gao W, et al. Unusual Case of Acute Type A Aortic Dissection During TAVR Bailout With a Self-Expanding Valve. JACC Case Rep. 2025;103919. Image Credit: Richman Photo – stock.adobe.com