An 86 year-old male presented with progressive shortness of breath – NYHA class III, with a PMH of atrial fibrillation, TIA, s/p PPM in 2012, s/p DES (Mid LAD) & CB PTCA of D1. TTE revealed severe AS, peak/mean aortic gradient = 70/42 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4.1 m/sec and LVEF 68%. CT angio showed minimum diameters of 0.8 x 0.8 cm for right and 0.9 x 0.8 cm for the left common femoral arteries and aortic annulus of 2.2 x 3.0 cm (average 2.6). The STS risk mortality is 4.63 and the Logistic Euroscore mortality is 16.60. Patient was determined to be high risk for surgical AVR due to advanced age, frailty and pulmonary hypertension. Patient is now planned for CoreValve TAVR (31mm) via percutaneous femoral access under conscious sedation.
