An 86 year-old male presented with progressive shortness of breath– NYHA class III, with a history of hypertension, III vessel CAD s/p PCI, Asthma/COPD, BPH, Glaucoma, and pleural effusion s/p thoracotomy. TTE revealed severe AS, peak/mean aortic gradient = 108/62 mmHg, AVA = 0.5 sq cm, aortic peak velocity = 5.1 m/sec and LVEF 61%. CT angio showed minimum diameters of 0.8 x 1.0 cm for right and 0.8 x 0.9 cm for left common femoral arteries and aortic annulus of 2.8 X 2.0 cm (average 2.4 cm). The STS risk mortality is 4.4 % and the Logistic Euroscore mortality is 13.14 %. Patient was determined to be high risk for surgical AVR due to COPD and frailty. Patient is now planned for CoreValve Evolut-R TAVR (29mm) via percutaneous femoral access under conscious sedation.
