Case and Plan:
72-year-old female presents with worsening NYHA Class III symptoms of heart failure for the last 3 months. Past medical history is significant for morbid obesity (BM1-37.6kg/m2) and Non-obstructive CAD. Recent transthoracic echocardiogram revealed LVEF of 60%, severe valvular aortic stenosis (PG/MG/AVA/PV: 81/49/0.8/4.5), mild AR and trace MR. CTA showed severe trileaflet aortic valvular stenosis with calcium score 1342 and low left main (LM) coronary height of 5.4mm. Her STS PROM risk for AVR was calculated at 1.8%. Heart Team evaluation found her to be low STS risk. Patient preferred TAVR over SAVR. Now planned for trans-femoral TAVR via left percutaneous femoral arterial access using a 23mm Sapien-3 Ultra valve with LM protection.