Aortic Dissection After TAVR: Mechanisms, Management, and Outcomes From a Single-Center Experience

Background: Aortic dissection is a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR), with limited data on mechanisms, management, and outcomes. Objectives: To describe the incidence, mechanisms, management, and outcomes of aortic dissection complicating TAVR. Methods: We retrospectively analyzed patients developing perioperative acute aortic dissection during TAVR between 2014 and September 2025. The primary outcome was in-hospital mortality. Results: Among 2,646 TAVR procedures, 10 patients (0.38%) developed acute aortic dissection. Mean age was 83 ± 8 years, 70% were female, and mean Society of Thoracic Surgeons risk of mortality was 3.6% ± 3.4%. Six dissections (60%) were Stanford type A and 4 (40%) type B. Suspected mechanisms included delivery system manipulation (60%) and wire/catheter trauma (40%). Management consisted of open surgery (30%), endovascular/hybrid intervention (40%), or conservative treatment (30%). In-hospital and 30-day mortality were 40%. Conclusions: Aortic dissection after TAVR is rare but associated with substantial early mortality, requiring prompt recognition and individualized multidisciplinary management.