Redo-TAVR for Degenerated TAV with HALT using Evolut Fx+ Valve – October 2024

Case and Plan:

81-year-old female presents with progressive dyspnea and fatigue. Past medical history is significant for HTN, HLD, CAD (s/p LHC 5/2018 with moderate LCX stenosis), severe AS s/p TAVR 5/9/18 (23mm Edwards Sapien-3 Ultra valve @ OSH which was complicated by bleeding into the right kidney), thrombocytopenia and HALT of TAVR valve (on Eliquis since 3/2024).TTE on 10/2/24 showing, Severe bioprosthetic Aortic Stenosis (EF= 67%, AVA 0.61 sqcm, PG/MG 110 mmHg/ 63 mmHg, PV 5.26 m/s), Mild to Moderate AR. CTA on 5/20/24 with HALT and restricted motion of the posterior bioprosthetic leaflet.  The heart team found the patient at extreme risk for TAVR explant and recommended Redo -TAVR. Now planned for TF Redo-TAVR using a 26 mm Medtronic Evolut Fx+ in a degenerated 23 mm Sapien-3 Ultra valve via left percutaneous femoral arterial access with Shockwave IVL under TEE guidance.

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