91 year old female presents with progressive exertional dyspnea (NYHA Class III) and decreased exercise tolerance <1 block for the last 2 months. Past medical history is significant for severe aortic stenosis s/p BAV on 11/21/16 (refused further therapy at that time), hypertension, hyperlipidemia, mild non-obstructive CAD, COPD, diverticulosis, osteoporosis and osteoarthritis. Recent echocardiogram revealed severe calcific aortic stenosis (PG/MG/AVA = 98mmHg/63mmHg/0.4cm2) and LVEF 64%. Analysis of lower extremity on CT angiogram revealed adequate diameter for trans-femoral approach. The aortic annulus measured 17.9 x 25.4 mm (mean 21.7 mm), annular perimeter was 70.5 mm and the annular area was 386.7 mm2. The STS mortality risk for surgical AVR was 9.19% and the logistic Euroscore mortality risk was 22.7%. The patient underwent Heart Team evaluation and was found to be at high risk for SAVR due to comorbidities, advanced age and frailty. Now presents for TAVR with 26 mm Evolut-PRO Corevalve via a right percutaneous femoral approach with Sentinel cerebral protection device.
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.
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 […]