Structural heart cases
TAVR with 23mm Sapien-3 – November 2017
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84 year old female presented with progressive dyspnea (NYHA Class III) and a decrease in exercise tolerance <1 block. Past medical history is significant for severe aortic stenosis, CAD (s/p PCI to mLAD 2017), diabetes mellitus (diet controlled), hypertension, hypercholesterolemia and chronic renal impairment. Recent echocardiogram revealed severe aortic stenosis (PG/MG/AVA 75mmHg/44mmHg/0.80cm2) and LVEF of 60%. CT angiogram revealed left lower extremity had minimal diameter > 6mm but the right lower extremity artery access was < 6mm. The aortic annulus measured 18x26mm (average 22mm) and the annular area was 376mm2 and perimeter of 70.9mm. STS mortality risk for surgical AVR was 4.3% and the logistic Euroscore mortality risk was 10.1%. Patient underwent Heart Team evaluation and was found to be at prohibitive risk for SAVR due to porcelain aorta. Now presents for TAVR with 23mm Edwards Sapien-3 valve via the left percutaneous femoral approach.

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One thought on “TAVR with 23mm Sapien-3 – November 2017”

  1. Sibi Thomas says:

    Hello I’m a structural fellow and a few things I noticed that was different and would like your opinion on is. After you crossed with the straight wire, I was taught not to push the AL2 into the LV since its essentially creating a stiffer straight wire and can potentially increase the risk of perforation. What we do is, after we insert the straight wire, we keep pushing so it makes a nice C or U shaped curve at the apex. Then we walk out the AL2 and just go in with a pig tail and pull the straight wire out. It essentially saves a step from what I saw here.

    Then a big difference I saw and was shocked at was, after you line up the S3 and inject with the pigtail to line up the valve. Then you pull the pigtail back and assume the valve didn’t move. We pull the pigtail back just to the top of the valve (most facilities dont even pull the pigtail, edwards states it doesn’t make a difference as long as the SOV is big), and then Pacing on, capture, then we inject one more time, (it will confirm one more time the valve hasn’t moved) and then everyone quickly agrees and then inflates the balloon and deploys the valve.


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