Case Report Combined Surgical and Catheter-Based Treatment of Extensive Thoracic Aortic Aneurysm and Aortic Valve Stenosis Ole De Backer, 1 * MD, PhD, Lars L € onn, 2,3 MD, PhD, and Lars Sïndergaard, 1 MD, DMSC An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter- based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR. V C 2014 Wiley Periodicals, Inc. Key words: aortic valve disease; percutaneous intervention; aortic repair; endovascu- lar; stent graft INTRODUCTION An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a tech- nical challenge to surgeons. Traditional repair comprises a two-stage operation using the elephant trunk technique, which has reduced the morbidity and mortality of subse- quent surgery [1–3]. In addition, endovascular stenting has been applied to complete the second stage of the repair as a minimally invasive hybrid option [4–6]. Thoracic endovascular aneurysm repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. Fundamentally, it is a far less invasive approach than open surgery and its availability and relative ease of application has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery [7]. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symp- tomatic severe aortic valve stenosis (AS) who are consid- ered at high risk for surgical aortic valve replacement [8]. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To the best of our knowledge, this is the first report of a hybrid TAA repair procedure combined with a TAVR. CASE REPORT A 78-year-old woman with a history of hypertension and known with an extensive TAA was referred to our 1 Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark 2 Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark 3 Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark Conflict of interest: Nothing to report. *Correspondence to: Ole De Backer, MD, PhD, Consultant Interven- tional Cardiology, Kardiologisk klinik B 2011, Rigshospitalet, Bleg- damsvej 9, 2100 Copenhagen Ø, Denmark. E-mail: ole.debacker@gmail.com Received 10 March 2014; Revision accepted 29 June 2014 DOI: 10.1002/ccd.25592 Published online 00 Month 2014 in Wiley Online Library (wileyon- linelibrary.com) V C 2014 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 00:00–00 (2014)