TAVR in a Patient with Prior Mitral Valve Replacement – September 2018

87 year old female presents with progressive exertional dyspnea (NYHA Class III) for the last 3 months. Past medical history is significant for severe aortic stenosis, previous bio-prosthetic MVR and TV Repair in 05/28/14, thrombocytosis, atrial fibrillation on warfarin, stage III CKD, hypertension and hyperlipidemia. Recent echocardiogram revealed severe calcific aortic stenosis (PG/MG/AVA = 62/42/0.92) and LVEF 64%. Analysis of lower extremity on CT angiogram revealed adequate diameter for trans-femoral approach. The aortic annulus measured 19.8 x 26.1 mm (mean 23 mm), annular perimeter was 71.7mm and the annular area was 392.7mm2. The STS mortality risk for surgical AVR was 8.34% and logistic EuroScore mortality risk was 32.2%. The patient underwent Heart Team evaluation and was found to be at high risk for SAVR. Now presents for TAVR with 29mm Evolut-PRO CoreValve via right percutaneous femoral approach with Sentinel cerebral protection device.

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