94 year old female presented with progressive dyspnea (NYHA Class III) and lower extremity edema. Past medical history is significant for severe aortic stenosis, CAD (s/p PCI to pLAD and D1 on 01/09/2018), hypertension, hypercholesterolemia and chronic atrial fibrillation (on rivaroxaban). Recent echocardiogram revealed paradoxical low flow low gradient severe aortic stenosis (PG/MG/AVA 35mmHg/25mmHg/0.6cm2) with dimensionless index (DI) = 0.22 and LVEF of 60%. Analysis of lower extremities on CT angiogram revealed adequate diameter for trans-femoral approach. The aortic annulus measured 19.8×24.8mm (average 22.3 mm) and the annular area was 386mm2 and perimeter of 70.7mm. STS mortality risk for surgical AVR was 9.5% and the logistic Euroscore mortality risk was 45%. Patient underwent Heart Team evaluation and was found to be at high risk for SAVR due to comorbidities, advanced age and frality. Now presents for TAVR with 26mm Evolut-PRO CoreValve via the right 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.