Case and plan :
TF-TAVR with a 29mm Sapien-3 Ultra Resilia valve in a Low Flow Low Gradient Severe Aortic Stenosis with CKD stage IV
Presentation: Worsening NYHA III HF symptoms (SOB and fatigue)
PMH: HTN, HLD, HFrEF (EF 45%), CKD Stage 4 (e GFR 24.34 mL/min/1.73 m2), prostate cancer (s/p seed therapy), gout, anxiety and CLL (s/p chemotherapy 2000). s/p CRT-D 9/8/21
Medications: Metoprolol, Apixaban, Hydralazine, Mexilitine, Atorvastatin, Bumetanide
Labs: Hgb 14.0, PLT 152K, Na 141, K 4.0, Cr 2.54, INR 1.4
EKG (06/12/2023): AF with controlled HR of 60 bpm and QRS of 114 msec.
TTE (06/15/2023): Moderately decreased left ventricular systolic function, EF 40%, Severe LFLG aortic stenosis (PG/MG/PV/AVA: 35/22/2.96/0.47). SVI 13ml/M2.
Cath (2020): Non-Obstructive CAD
