79 year old female presented with progressive dyspnea (NYHA Class III) and a decrease in exercise tolerance <1 block. Past medical history is significant for severe aortic stenosis, CAD (s/p PCI in 2008), diabetes mellitus, hypertension, hypercholesterolemia, pulmonary hypertension, hepatitis C, non-hodgkins lymphoma, hypothyroidism, DJD spine and GERD . Recent echocardiogram revealed progression to severe aortic stenosis (PG/MG/AVA 74mmHg/50mmHg/0.57cm2) and LVEF of 58%. CT angiogram revealed bilateral lower extremity and left upper extremity arterial access had minimal diameter < 6mm but the right upper extremity artery access >6mm. The aortic annulus measured 21x26mm (average 23.6mm) and the annular perimeter was 76mm. STS mortality risk for surgical AVR was 3.6% and the logistic Euroscore mortality risk was 8.9%. Patient underwent surgical evaluation and was found to be at high risk for SAVR. Now presents for TAVR with 29mm Evolut-R CoreValve via the right subclavian artery cutdown.
