An 84 year-old male presented with NYHA class III heart failure associated with progressive weakness and dyspnea. TTE revealed severe AS, peak/mean aortic gradient = 63/42 mmHg, AVA = 0.8 sq cm, aortic peak velocity = 4.0 m/sec and LVEF 60%. CT angio showed minimum diameters of 0.8 x 0.7 cm for right and 0.9 x 1.0 cm for the left common femoral arteries and aortic annulus of 2.2 x 2.8 cm (average 2.5). The STS risk mortality is 2.6% and the Logistic Euroscore mortality is 18.1%. Patient was determined to be extreme risk for surgical AVR due to localized lung cancer with projected life expectancy of 2-3 years. Patient is now planned for CoreValve TAVR (29mm) via percutaneous femoral access under conscious sedation.
