Case and Plan:
73-year-old male presents with progressive dyspnea and fatigue. Past medical history is significant for HTN, HLD, DM, hepatocellular cancer 5/2015 s/p R hepatectomy c/b incision hernia (large spigelian hernia; on Entecavir), ESRD on HD since 2020, CAD s/p PCI of LAD (2021), Severe AS s/p TAVR # 23mm Sapien 3 Ultra (8/2021). TTE & TEE showed LVEF 60% with degenerated TAV with calcified leaflets and severe prosthetic valve stenosis (PG/MG/ PV /AVA: 58/35/0.63/3.8/0.66) and moderate AR. The heart team found the patient at extreme risk for TAVR explant and recommended TAVR. Now planned for TF- Redo TAVR using a 23 mm SAPIEN 3 Ultra RESILIA in a degenerated 23 mm SAPIEN 3 valve via right percutaneous femoral arterial access under TEE guidance.
