An 88 year-old female presented with progressive shortness of breath – NYHA class III, with a history of hypertension, chronic diastolic HF, COPD and s/p BAV on 7/2/15. TTE revealed severe AS, peak/mean aortic gradient = 65/44 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4 m/sec and LVEF 65%. CT angio showed minimum diameters of 0.4 x 0.7 cm for right and 0.6 x 0.6 cm for the left common femoral arteries and aortic annulus of 2.5 x 2.1 cm (average 2.3). The STS risk mortality is 5.15 and the Logistic Euroscore mortality is 12.81. Patient was determined to be extreme risk for surgical AVR due to advanced age and marked, generalized frailty. Patient is now planned for CoreValve Evolut R TAVR (26mm) via percutaneous femoral access under conscious sedation.
