Transcatheter aortic valve implantation after branched thoracic endovascular aortic repair in zone 0.

An 83-year-old woman who underwent emergent hemi-arch replacement for acute aortic dissection (Stanford Type A) and staged branched thoracic endovascular aortic repair in zone 0 was admitted for severe aortic stenosis. We performed transfemoral transcatheter aortic-valve implantation with an SAPIEN 3 valve. The interference between the stent frames of the valve and the stent grafts in the aortic arch was concerning. However, using the SAPIEN 3 valve's flex system, the valve was successfully delivered through the complex structure in the aortic arch without any aggravation. The patient's postoperative course was uneventful.