SAPIEN 3 TAVR (26mm) via Percutaneous Femoral Access – January 2017

84 year old female presented with chest pain and dyspnea on exertion (NYHA III). Her past history was significant for hypertension, hyperlipidemia, and DVT. TTE revealed severe valvular aortic stenosis; peak gradient = 68 mmHg, mean gradient = 41 mmHg, Doppler valve area = 0.7cm2, Aortic peak velocity = 4.1m/sec and LVEF of 51 %. Coronary angiogram showed mild (30-50%) mid LAD disease only. CT angiogram revealed minimum diameters of 8mm for bilateral common iliac arteries and aortic annulus of 21.6 X 26.7mm (average 24.4 mm) with an annular circumference of 75mm. Coronary ostial height was 10mm for left main and 15mm for RCA. The STS mortality risk for Surgical AVR is 3.4 % and the Logistic Euroscore mortality risk is 10.1%. Patient was determined to be intermediate risk for SAVR. Now planned for high risk TAVR with Sapien S3 (26mm) via percutaneous femoral access under conscious sedation and pre-empt LM protection.

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