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.
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.