Case and Plan:
88-year-old female with prior 23mm SAPIEN-3 Ultra TAVR for severe aortic stenosis, presents with exertional fatigue and breathlessness. Her past medical history includes HTN, TIA (2018), H. Pylori gastritis, AVM (s/p ablation), ex-smoker. Her TTE/TEE showed EF 60%, moderate to severe paravalvular leak with aortic valve mean gradient 12mmHg, minimal MR, mild TR. The heart team found the patient at extreme risk for TAVR explant and surgical AVR and recommended TF redo-TAVR using 26mm SAPIEN-3 Ultra Resilia (-1cc) with left main protection.
