96 year old male presents with progressive exertional dyspnea (NYHA Class III) for the last 4 months. Past medical history is significant for severe aortic stenosis (AS), non-obstructive CAD, hypertension, hyperlipidemia, diabetes, atrial fibrillation on anticoagulation and prostate cancer in remission. Recent echocardiogram revealed severe calcific aortic stenosis (PG/MG/AVA = 29/16/0.7) and LVEF 53% with stroke volume index of 27.6 ml/m2 low flow-low gradient paradoxical severe AS (LF-LG AS). Analysis of lower extremity on CT angiogram revealed adequate diameter for trans-femoral approach. The aortic annulus measured 27.5 x 33.5 mm (mean 30.5 mm), annular perimeter was 95.5 mm and the annular area was 713.4 mm2. The STS mortality risk for surgical AVR was 12.0% and logistic Euroscore mortality risk was 37.09%. The patient underwent Heart Team evaluation and was found to be at extreme risk for SAVR due to advanced age and frailty. Now presents for TAVR with a 29 mm (+2cc) SAPIEN-3 via right percutaneous femoral approach with Sentinel cerebral protection device.
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 […]
TAVR using Transcarotid Access – March 2020
Tags: TAVR | Transcarotid Access
Case and Plan: 73-year-old male with hypertension, hyperlipidemia, parathyroidectomy, renal cell carcinoma s/p nephrectomy and right renal transplant in 2001 on chronic steroids and immunosuppressant therapy, paroxysmal atrial fibrillation on AC with warfarin, chronic diastolic heart failure and severe PAD presents with progressive exertional dyspnea NYHA-Class III for the past month after walking up to […]
TAVR with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
Tags: Structural | Structural heart | TAVR
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 […]