Valve-in-Valve TAVR with 26mm SAPIEN-3 – March 2019
79 year old man presents with worsening exertional dyspnea (NYHA Class III) for the last 3 months. Patient has required multiple recent admissions to hospital with CHF exacerbation requiring IV diuretics. Past medical history is significant for symptomatic bicuspid aortic valve with dilated ascending aorta s/p Bentall procedure (2011) with 25 mm Carpentier-Edwards pericardial valve inside 30 mm Hemashield tube, atrial fibrillation on warfarin, hypertension, and dyslipidemia. Recent echocardiogram revealed bio-prosthetic valve degeneration with severe aortic regurgitation without significant stenosis and depressed LVEF of 40%. Coronary angiogram showed non-obstructive CAD. Analysis of lower extremities on CT angiogram revealed adequate diameters for trans-femoral approach. The Internal Diameter of surgical AV measured 22.1×25.7 mm (mean 23.9 mm), perimeter 76 mm and the area 454.8 mm2. The STS mortality risk for surgical AVR was 8.37% and logistic Euroscore mortality risk was 19.37%. The patient underwent Heart Team evaluation and was found to be at high risk for re-do SAVR due to comorbidities and frailty. Now presents for Valve-in-Valve TAVR with 26 mm SAPIEN-3 Valve +/- bio-prosthetic valve fracture via left percutaneous femoral approach with Sentinel cerebral protection device.
TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
Case and Plan: 104 year-old-female with cardiomyopathy, kyphoscoliosis, pleural effusion s/p thoracentesis, NSVT now presents with progressive exertional dyspnea (NYHA Class III) for few months. Patient underwent urgent balloon aortic valvuloplasty in August 2020 in setting of acute congestive heart failure and severe aortic stenosis. Recent transthoracic echocardiogram revealed LVEF of 35% and severe […]
Bioprosthetic Aortic ViV TAVR after Valve Fracture and Evolut Pro+ Implantation – November 2020
Case and Plan: 60 year-old male presents with worsening exertional dyspnea (NYHA Class III) and multiple admissions for CHF exacerbation in past 3 months. Past medical history is significant for symptomatic severe aortic insufficiency s/p bioprosthetic AVR (2017) with 23mm Magna 3000 valve, ESRD on HD, HTN and HLD. Recent echocardiogram revealed bioprosthetic valve […]
TF-TAVR with No Contrast – September 2020
Case and Plan: 61 year-old-male with ETOH abuse, hepatitis and cirrhosis s/p Liver transplant in 6/2019 at MSH with postop course notable for AKI requiring dialysis (last dialysis 7/6/2019), Hypertension, Anemia, Former smoker, CKD stage III.
Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
Case and Plan: 74-year-old male former smoker with PMHx of HTN, HLD, and A Fib (on Eliquis) had IW-STEMI on 02/09/20. Cath showed occluded mRCA with dLM bifurcation disease; S/p DES-PPCI to mRCA. Transthoracic echocardiogram at the time of discharge showed an EF of 55% with moderate MR. Pt had staged PCI to dLM […]