26mm Evolut-PRO CoreValve TAVR – March 2018
1566 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.
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Tags: TAVR | Transcarotid Access
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Tags: Structural | Structural heart | TAVR
717 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 […]
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