A 89 year-old male presented with worsening dyspnea on exertion– NYHA class III and fatigue, with history of hypertension, hyperlipidemia and multiple prior PCIs. Patient also suffers from mild cognitive impairment as a result of childhood meningitis. TTE revealed severe valvular aortic stenosis; peak gradient = 88 mmHg, mean gradient = 58 mmHg, Doppler valve area = 0.66cm2, Ao peak velocity = 4.7m/sec and LVEF of 63 %. Cardiac cath showed non-obstructive CAD with patent stents. CT angiogram revealed minimum diameters of 10.5mm for bilateral common iliac arteries and aortic annulus of 25.2 X 21.3 mm (average 23.2mm) with an area of 410mm2. The STS mortality risk for Surgical AVR is 1.5% and the Logistic Euroscore mortality risk is 11.3%. Patient was determined to be intermediate risk for SAVR due to age and neurological dysfunction and is now planned for TAVR with Edwards Sapien 3 (23 mm) valve via percutaneous femoral access under conscious sedation.
