CASE & Plan:
88-year-old male presents with worsening shortness of breath, dizziness, and NYHA Class III symptoms of heart failure. Past medical history is significant for hypertension, hyperlipidemia, COPD (on inhaler), stage 3 CKD, anemia, PAD with distal aortic occlusion, lung cancer (S/P bilateral lung resection 2009-2010 with recurrence of left lung cancer S/P chemotherapy x 5 2011-2015), subdural hematoma (11/2021, without deficit) and non-obstructive CAD. Echocardiogram revealed severe aortic stenosis (PG/MG/PV: 63/38/3.98), mild MR and LVEF 60%. CTA measurement indicates the patient is suitable for TAVR. The patient’s STS PROM risk for SAVR is 3.95%. Heart Team evaluation deemed the patient at extreme risk for surgery and appropriate for trans-carotid TAVR due to severe PAD with abdominal aorta occlusion. Now planned for trans-carotid TAVR via right carotid arterial cut down using 26mm SAPIEN-3 Ultra Valve.
