80-year-old female presents with progressive dyspnea NYHA class IV over the last 6 months and multiple heart failure admissions. Past medical history of chronic AFib-(On Apixaban), COPD (on home O2), hypertension, Diabetes Mellitus (on insulin), hypothyroidism, hyperlipidemia, obesity (BMI 36), bilateral knee Sx, bladder Ca post Sx, and chronic left leg ulcer. A recent TTE showed severe aortic stenosis (PG/MG/PV/AVA 80/32/4.5/1.0) and LVEF 65%. Patient was evaluated by the Heart Team and was deemed extreme risk for SAVR in view of body habitus, multiple co-morbities and poor functional status. CTA showed small aortic annulus of 19.9*22.5mm (Avg 21.2mm), annular area of 351mm2 and perimeter of 66.9mm. The patient is now planned for a TAVR with a 26mm Evolut Fx+ valve via right transfemoral approach.
