Valve-in-Valve TAVR with 29mm Evolut-R CoreValve – January 2019
79 year old man presents with progressive exertional dyspnea (NYHA Class III) for the last 2 months. Past medical history is significant for CABG (SVG to D1 and SVG to RPL) & bioprosthetic surgical AVR (25mm Perimount 2700) in 03/09/04, atrial flutter s/p ablation, hypertension and hyperlipidemia. Recent echocardiogram revealed severe bioprosthetic aortic regurgitation due to leaflet degeneration and coaptation gap, moderate prosthetic aortic stenosis (PG/MG/AVA = 41/20/0.9) and LVEF 40-45%. Analysis of lower extremity on CT angiogram revealed adequate diameter for trans-femoral approach. The Internal Diameter of Surgical AV measured 23.1×24.6 mm (mean 23.8 mm), perimeter was 75.3mm and the area was 449.9mm2. The STS mortality risk for surgical AVR was 3.5% and logistic Euroscore mortality risk was 19.4%. The patient underwent Heart Team evaluation and was found to be at high risk for re-do SAVR due to comorbidities, advanced age and frailty. Now presents for Valve-in-Valve TAVR with 29mm Evolut-R CoreValve via left percutaneous femoral approach with Sentinel cerebral protection device.
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.
Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
Case and Plan: 74-year-old male former smoker with PMHx of HTN, HLD, and A Fib (on Eliquis) had IW-STEMI on 02/09/20. Cath showed occluded mRCA with dLM bifurcation disease; S/p DES-PPCI to mRCA. Transthoracic echocardiogram at the time of discharge showed an EF of 55% with moderate MR. Pt had staged PCI to dLM […]
TAVR using Transcarotid Access – March 2020
Tags: TAVR | Transcarotid Access
Case and Plan: 73-year-old male with hypertension, hyperlipidemia, parathyroidectomy, renal cell carcinoma s/p nephrectomy and right renal transplant in 2001 on chronic steroids and immunosuppressant therapy, paroxysmal atrial fibrillation on AC with warfarin, chronic diastolic heart failure and severe PAD presents with progressive exertional dyspnea NYHA-Class III for the past month after walking up to […]
TAVR with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
Tags: Structural | Structural heart | TAVR
Case and Plan: 81-year-old female with hypertension, ex-smoker, and chronic diastolic heart failure now presents with progressive exertional dyspnea NYHA Class III for the past month after walking up to 1 block. She was noted to have right lower lobe subsegmental pulmonary embolism on recent CT with evidence of old DVT requiring anticoagulation. Echo revealed […]