Structural heart cases
Valve-in-Valve TAVR with 26mm SAPIEN-3 – March 2019

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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.

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TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021 (Edited Version)
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Case & Plan: 68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o […]


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TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021
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Case & Plan: 68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o […]


TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
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  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 […]