A 76 year-old female with H/O multiple PCI’s and metastatic breast cancer presented with progressive symptomatic severe aortic stenosis, confirmed on cath with AVA 0.6 sq cm. TTE revealed severe AS, peak/mean aortic gradient = 64/48 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4.2 m/sec and LVEF 60%. CT angio showed minimum diameters of 0.8 x 0.8 cm for Right and 0.8 x 0.7 cm for the Left common femoral arteries and aortic annulus of 2.1 x 2.7 cm (average 2.4). The STS risk mortality is 4.2 and the Logistic Euroscore mortality is 11.7. Patient was determined to be extreme risk for surgical AVR due to metastatic cancer (responding to chemotherapy) with projected life expectancy of 2-3 years. Patient is now planned for CoreValve TAVR (29mm) via percutaneous femoral access under conscious sedation.
