Case & Plan:
73-year-old male presents with worsening NYHA Class III symptoms of heart failure for the last 4-5 months. Past medical history is significant for severe restrictive lung disease, home oxygen use, HTN, HLD, IDDM, OA, CAD and aortic stenosis s/p AVR and CABG (in 2012 with 21mm MitroFlow bio-prosthetic valve and LIMA to LAD, SVG to OM, RPDA, RPL). Recent TT echocardiogram revealed LVEF of 46%, moderate TR/MR, abnormal aortic bio-prosthesis with moderate to severe regurgitation and mean gradient of 25mmHg. His STS PROM risk for redo-AVR was calculated at 9.3%. Heart Team evaluation found him to be at high risk for SAVR. Now planned for trans-femoral ViV TAVR via right percutaneous femoral arterial access using a 23mm Evolut Pro + valve with Sentinel cerebral embolic protection device.