Case and Plan
84-year male presents with dyspnea on walking <1 block and presyncope. Past medical history of CABG x 4 (1994), HTN, DM, PVD and right carotid stenosis. He underwent TAVR with 29mm Evolut FX (11/23) which was complicated by valve embolization & aortic root dissection. The index valve was deployed in the ascending aorta and a second 29mm Evolut FX was deployed in the aortic annulus. TEE (2/7/24) showed moderate to severe PVL with multiple jets. Mean aortic valve gradient was 6mmHg. The heart team found the patient at high risk for TAVR explant and SAVR, and TAV-in-TAV was recommended. Now planned for TAV-in-TAV via right percutaneous access using a 26mm SAPIEN-3 Ultra Resilia valve and Sentinel embolic protection.
