Structural heart cases
TAVR using Transcarotid Access – March 2020

Case and Plan:

73-year-old male with hypertension, hyperlipidemia, parathyroidectomy, renal cell carcinoma s/p nephrectomy and right renal transplant in 2001 on chronic steroids and immunosuppressant therapy, paroxysmal atrial fibrillation on AC with warfarin, chronic diastolic heart failure and severe PAD presents with progressive exertional dyspnea NYHA-Class III for the past month after walking up to 1 block which is relieved by rest. Echo revealed severe calcified trileaflet aortic valve stenosis with AVA/PG/MG/PV of 0.7/73/41/4.3 with EF of 65%. Recent angiogram revealed non-obstructive CAD. The aortic annulus measured 21.8 x 28.5 mm (mean-25.1mm), annular perimeter was 80.1mm and the annular area was 493.5 mm2. The STS mortality risk for surgical AVR was 3.6%. The patient underwent Heart Team evaluation and was found to be at very high risk for SAVR due to comorbidities, and frailty. Analysis of lower extremity on CT angiogram revealed severe calcification of femoral arteries and transplanted kidney on the right side. Considering his poor femoral anatomy, options of alternative accesses were considered. Therefore, TAVR with a 26 mm SAPIEN-3 Ultra valve is planned via right carotid cutdown approach.

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