STRUCTURAL HEART
TAVR 29mm Sapien-3 – November 2018
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96 year old male presents with progressive exertional dyspnea (NYHA Class III) for the last 4 months. Past medical history is significant for severe aortic stenosis (AS), non-obstructive CAD, hypertension, hyperlipidemia, diabetes, atrial fibrillation on anticoagulation and prostate cancer in remission. Recent echocardiogram revealed severe calcific aortic stenosis (PG/MG/AVA = 29/16/0.7) and LVEF 53% with stroke volume index of 27.6 ml/m2 low flow-low gradient paradoxical severe AS (LF-LG AS). Analysis of lower extremity on CT angiogram revealed adequate diameter for trans-femoral approach. The aortic annulus measured 27.5 x 33.5 mm (mean 30.5 mm), annular perimeter was 95.5 mm and the annular area was 713.4 mm2. The STS mortality risk for surgical AVR was 12.0% and logistic Euroscore mortality risk was 37.09%. The patient underwent Heart Team evaluation and was found to be at extreme risk for SAVR due to advanced age and frailty. Now presents for TAVR with a 29 mm (+2cc) SAPIEN-3 via right percutaneous femoral approach with Sentinel cerebral protection device.

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87 year old male with known history of mitral regurgitation, hypertension, hyperlipidemia, CAD s/p DES PCI to RCA (2010 and 2015), ischemic cardiomyopathy, carotid artery stenosis, and frailty presents with worsening dyspnea on exertion NYHA Class III for 6 months.