Case and Plan:
A 69-year-old man with prior SAVR (23 mm Edwards inspiris valve), SMVR (25 mm Edwards Mitris valve), and tricuspid repair (28 mm Tri-Ad II) in 2022, now presents with progressive NYHA Class III dyspnea over the past 6 months. PMH includes PAD s/p Covera stent from the left common femoral artery to vein, hepatitis C, alcoholic cirrhosis and portal vein thrombosis, and IDDM. Recent TEE showed normal LVEF, bioprosthetic AV degeneration with severe stenosis, mild regurgitation (PG/MG 66/32 mmHg, AVA 0.89 cm², DVI 0.23, and SVI 38.3 mL/m²), and mild mitral bioprosthetic stenosis. Preprocedural CTA demonstrated a prior 23-mm Inspiris surgical valve with true ID 21 mm, valve to LCA distance 3.7 mm and low risk of coronary obstruction. The patient was evaluated by the Heart Team and deemed to be at extreme surgical risk for reop SAVR. Patient is planned to undergo ViV TAVR with pre-balloon valve remodeling of the Inspiris valve followed by implantation of a 23-mm SAPIEN-3 Ultra Resilia valve, via a right transfemoral approach.
