CASE & Plan:
79 year old man presenting with worsening dyspnea on exertion. Past medical history is significant for hypertension, dyslipidemia, CAD s/p multiple PCIs, non-Hodgkin’s lymphoma (s/p RTx), CKD and severe aortic stenosis (PG/MG/AVA: 49/26/0.8). TAVR CTA demonstrated a severely calcified aortic valve (valve calcium score 2363), horizontal aorta with an incidental 6.4cm fusiform dilation of the infra-renal aorta.
The patient’s STS-PROM score for surgery was 1.9% but hostile mediastinum from radiotherapy. Following Heart team discussions including vascular surgical input, decision made to proceed with combined TAVR with Endovascular Aneurysm Repair (EVAR) for AAA to mitigate risk of acute aortic complications. Patient is planned for TF TAVR via right percutaneous femoral artery access using 26mm SAPIEN 3 Ultra RESILIA with combined EVAR for AAA with Sentinel cerebral embolic protection.