An 84 year-old male presented with progressive shortness of breath and chest discomfort – NYHA class II, with a history of hypertension, I vessel CAD, COPD, TIA, s/p BAV on 10/2/15, s/p rt. radical nephrectomy, stage III CKD, and h/o CA prostrate. TTE revealed severe AS, peak/mean aortic gradient = 85/56 mmHg, AVA = 0.8 sq cm, aortic peak velocity = 4.6 m/sec and LVEF 77%. CT angio showed minimum diameters of 0.7 x 0.8 cm for right and 0.7 x 0.7 cm for left common femoral arteries and aortic annulus of 2.6 X 2.2 cm (average 2.4 cm). The STS risk mortality is 9.5 % and the Logistic Euroscore mortality is 20.27 %. Patient was determined to be very high risk for surgical AVR due to advanced age, high right diaphragm, renal insufficiency, COPD, and obesity. Patient is now planned for CoreValve Evolut-R TAVR (29mm) via percutaneous femoral access under conscious sedation.
