Case & Plan:
83 yrs, Male
Present Clinical Presentation:
Presented @OSC 1/23 with progressive angina and DOE with cath revealing 3V+LM CAD and severe AS, failed attempted PCI of RCA
CAD Risk Factors:
SAQ-7 score: 45 TIA, BPH
Known moderate CAD on cath in the past and was managed medically. Also known to have progressive AS and moderate LV dysfunction
ASA, Clopidogrel, Metoprolol XL, Amlodipine, Rosuvastatin, Metformin
Cath: Cath on 1/18/2023 in Philippines revealed extensive calcified 3 V+LM CAD: 95% calcified prox RCA lesions, 70% dLM, 90% calcified prox LAD, 80% mid LAD, 70% D1, 70% prox LCx-OM1, LVEF 40% and Syntax score 36 and STS risk 5.2%. PCI of RCA attempted but failed. Echo revealed severe AS (PG/MG/PV/AVA; 68/49/4.2/0.6), mod MR and mild pulm HTn, CT revealed AV anatomy appropriate for TAVR. Heart team discussion recommended high risk Protected PCI+ BAV as bridge to TAVR.
Plan: Now planned for BAV followed by Impella supported high risk PCI of RCA/LM/LAD lesions using RotaTripsy.