Case and Plan
78-year-old male presents with worsening NYHA Class III symptoms of heart failure for the last 3 months. Past medical history is significant for CAD s/p CABG X 4 in 1997 with redo sternotomy with SVG to RPDA and MVR/TVR in 2020, s/p multiple PCIs, HFrEF with EF 30%, AF/AFL, TIA, Carotid artery stenosis s/p LICA stent, type II DM, stage III CKD. Recent transthoracic echocardiogram revealed LVEF 32%, severe LFLG aortic stenosis (PG/MG/AVA/PV: 31/17/0.81/2.8) with adequate contractile reserve on DSE. Non-contrast CT showed moderate calcification 969. His STS PROM risk for AVR was calculated at 13.8%. Heart team evaluation found him to be at high risk for SAVR. Now planned for transfemoral TAVR via right percutaneous femoral arterial access using a 29mm Evolut PRO + valve with possible sentinel cerebral embolic protection device.
