Case and Plan:
69-year-old female presents with worsening NYHA Class III symptoms of heart failure for the last 3 months. Past medical history is significant for CAD, Prior PCI, HTN, HLP, DM, gastric bypass with hx for recurrent GIB due to small AVMs and osteoarthritis. Recent transthoracic echocardiogram revealed LVEF of 68%, severe valvular aortic stenosis (PG/MG/AVA/PV: 55/37/0.9/3.8), mild AR and mild MR with calcified mitral valve apparatus. CTA showed severe LVOT calcium. Her STS PROM risk for AVR was calculated at 2.4%. Heart Team evaluation found her to be at high risk for SAVR due to multiple comorbid conditions and recommended TAVR. Now planned for trans-femoral TAVR via right percutaneous femoral arterial access using a 26mm Evolut PRO+ valve with Sentinel cerebral embolic protection device.