Regarding “Rapid development of an iatrogenic aortic dissection following transcatheter aortic valve implantation”

Excerpt

We read with interest the paper by Geile and colleagues [1], and we would like to clarify some crucial points. Nowadays, the great majority of TAVI cases are performed through a trans-femoral (TF) access due to this technique having several advantages: it is completely percutaneous and it allows a quick and almost painless postoperative recovery. However, the most important drawback of TF-TAVI, as well as other types of trans-vascular accesses, is that it is based on a retrograde navigation through the vascular system with a potential risk of atherosclerotic plaque displacement causing distal embolization as well as plaque rupture resulting in aortic dissection. For these reasons, the choice of the most appropriate access should be based on a careful preoperative evaluation of patient anatomy considering vessel diameter, stenosis, tortuosity and the presence of atherosclerotic plaques and focal dissections. International guidelines recommend a “heart-team” approach for TAVI patients. Therefore, a preoperative multidisciplinary evaluation by interventional cardiologist, cardiac surgeon and anesthesiologist allows for an “unbiased” choice of the most appropriate treatment for each patient [2]. …