A 79 year-old female presented with worsening dyspnea on exertion– NYHA class III and fatigue, with a history of hypertension, HPL, left breast CA, obesity, non-ischemic CM, non-obstructive CAD, gastric bypass (1983), left mastectomy with reconstruction (1985) and AICD (2010). TTE revealed Severe valvular aortic stenosis; peak gradient = 64 mmHg, mean gradient = 44 mmHg, Doppler valve area = 0.63 sq cm, Ao peak CW velocity = 4 m/sec, LVEF 33 %. CT angio showed minimum diameters of less than 6 mm for bilateral common femoral arteries and aortic annulus of 2.6 X 2.2 cm (average 2.45 cm). The STS risk mortality is 3.0 % and the Logistic Euroscore mortality is 6.7%. Patient was determined to be high risk for surgical AVR due to history of breast CA (post radiation therapy) and non-ischemic cardiomyopathy. Patient is now planned for Evolut-R CoreValve TAVR (29 mm) via percutaneous femoral access under conscious sedation.
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