STRUCTURAL HEART
TAVR with 23mm Sapien-3 – November 2017
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84 year old female presented with progressive dyspnea (NYHA Class III) and a decrease in exercise tolerance <1 block. Past medical history is significant for severe aortic stenosis, CAD (s/p PCI to mLAD 2017), diabetes mellitus (diet controlled), hypertension, hypercholesterolemia and chronic renal impairment. Recent echocardiogram revealed severe aortic stenosis (PG/MG/AVA 75mmHg/44mmHg/0.80cm2) and LVEF of 60%. CT angiogram revealed left lower extremity had minimal diameter > 6mm but the right lower extremity artery access was < 6mm. The aortic annulus measured 18x26mm (average 22mm) and the annular area was 376mm2 and perimeter of 70.9mm. STS mortality risk for surgical AVR was 4.3% and the logistic Euroscore mortality risk was 10.1%. Patient underwent Heart Team evaluation and was found to be at prohibitive risk for SAVR due to porcelain aorta. Now presents for TAVR with 23mm Edwards Sapien-3 valve via the left percutaneous femoral approach.

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