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.
TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021
Case & Plan: 68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o […]
TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
Case and Plan: 104 year-old-female with cardiomyopathy, kyphoscoliosis, pleural effusion s/p thoracentesis, NSVT now presents with progressive exertional dyspnea (NYHA Class III) for few months. Patient underwent urgent balloon aortic valvuloplasty in August 2020 in setting of acute congestive heart failure and severe aortic stenosis. Recent transthoracic echocardiogram revealed LVEF of 35% and severe […]
Bioprosthetic Aortic ViV TAVR after Valve Fracture and Evolut Pro+ Implantation – November 2020
Case and Plan: 60 year-old male presents with worsening exertional dyspnea (NYHA Class III) and multiple admissions for CHF exacerbation in past 3 months. Past medical history is significant for symptomatic severe aortic insufficiency s/p bioprosthetic AVR (2017) with 23mm Magna 3000 valve, ESRD on HD, HTN and HLD. Recent echocardiogram revealed bioprosthetic valve […]
TF-TAVR with No Contrast – September 2020
Case and Plan: 61 year-old-male with ETOH abuse, hepatitis and cirrhosis s/p Liver transplant in 6/2019 at MSH with postop course notable for AKI requiring dialysis (last dialysis 7/6/2019), Hypertension, Anemia, Former smoker, CKD stage III.