Case and Plan:
84-year-old male with CAD s/p PCI for LCX and RCA, atrial fibrillation post ablation, prostate cancer post-surgery and hypothyroidism, presents with progressive shortness of breath on exertion. TTE shows severe AS (PG/MG/AVA/PV 64/43/0.73/4.0). In the CT evaluation, annulus was 28.2×21.2mm with area 452.9mm2 and perimeter 77.1mm; LVOT 28.3×17.7mm, which would be sized between a 23 – 26 mm Edwards SAPIEN or 29mm Evolut valve. STS risk mortality for SAVR was 1.95%. The heart team found the patient at intermediate surgical risk and appropriate for supra-annular self-expanding TAVR. Now TF TAVR using 29 mm Evolut FX+ via right percutaneous femoral arterial access is planned.
