Transcatheter aortic valve replacement via direct aortic access for severe aortic stenosis with double aortic arch

Transcatheter aortic valve replacement (TAVR) is an established treatment for managing severe aortic stenosis. Preoperative planning requires cautious identification of the access route, which can be challenging in patients with anatomical abnormalities of the aorta. Double aortic arch (DAA) is a congenital condition where the aorta bifurcates into two separate vessels that encircle the trachea and esophagus, thereby forming a vascular ring. This condition accounts for ~1% of congenital cardiovascular anomalies. Previous reports on TAVR performed on patients with DAA are limited, and there is no consensus on the appropriate access route. Herein, we present an 85-year-old female patient with DAA and aortic stenosis who underwent a successful TAVR using the direct aortic approach.