A 77 year-old male presented with progressive shortness of breath – NYHA class III, with history of atrial fibrillation and non-ischemic cardiomyopathy and TTE revealed severe AS, peak/mean aortic gradient = 76/45 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4.3 m/sec and LVEF 20%. CT angio showed minimum diameters of 0.9 x 1.0 cm for right and 0.9 x 1.0 cm for the left common femoral arteries and aortic annulus of 2.0 x 2.8 cm (average 2.4). The STS risk mortality is 3.87 and the Logistic Euroscore mortality is 34.8. Patient was determined to be high risk for surgical AVR due to severe cardiomyopathy, RV dysfunction and an EF of 20%. Patient is now planned for CoreValve TAVR (29mm) via percutaneous femoral access under conscious sedation.
