Case and Plan:
69-year-old male presents with progressive exertional dyspnea (NYHA Class III) over the past year. Past medical history is significant for hypertension, hyperlipidemia, monitored bicuspid AV with AS, CAD (s/p PCI of RCA, 2023), remote Bladder cancer (s/p TURBT), prostate cancer (s/p prostatectomy), lung cancer (s/p RUL lobectomy, 2004), and former smoker. Recent echocardiogram revealed severe bicuspid aortic stenosis (PG/MG/PV/AVA = 65/36/4/0.82), dilated ascending aorta 4.3 cm and LVEF 61%. The aortic annulus measured 19.4 mm x 28.5 mm (mean 24 mm), annular perimeter was 76.4 mm and the annular area was 435 mm2 with bicuspid morphology showing fused left-right raphe (Sievers Type 1).The STS mortality risk for surgical AVR was 0.9%. The patient underwent Heart Team evaluation and was found to be at low risk for SAVR but preference for TAVR over SAVR due to multiple oncologic comorbidities. Now planned for trans-femoral TAVR via right percutaneous femoral arterial access using a 23mm with +2 cc SAPIEN-3 Ultra valve with Sentinel cerebral embolic protection device.
