Case and Plan:
81-year-old male with a history of TAVR with a 29 mm Evolut FX+ for severe AS in March 2025, presented with progressive shortness of breath. TTE/TEE demonstrated LVEF 60%, normal functioning Evolut valve, but progression from mild-moderate to severe paravalvular leak (PVL), due to severe annular/LVOT calcification despite 2 balloon post dilatations during the index TAVR. Hemodynamic parameters were PV/PG/MG/AVA 1.8/13/6/2.0. CT revealed a large gap between the outer skirt of the Evolut valve and the native aortic root anatomy, consistent with severe PVL, and underexpanded Evolut valve. STS risk mortality for reop surgical AVR is 2.36%. The heart team found the patient at high risk for TAVR explant and surgical AVR. Patient is planned to undergo redo TAVR using 23 mm SAPIEN 3 Ultra Resilia for severe PVL of 29 mm Evolut FX+ with its outflow at node 4 via right percutaneous femoral arterial access.
