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.
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.