Case and Plan:
80-year-old male presents with exertional chest pain and worsening NYHA Class III symptoms of heart failure for the past months. Past medical history is significant for hypertension, hyperlipidemia, non-obstructive CAD, HEpEF, history of bioprosthetic aortic valve replacement, peripheral venous stents RLE, and LLE 2022 (on Rivaroxaban). A recent echocardiogram revealed severe bioprosthetic AS of prior 23 mm Perimount 8200 valve stenosis (PG/MG/PV: 85/51/4.6), mild to moderate MR, and mild TR. LV ejection fraction 50%. TEE reveals severe bioprosthetic AS and moderate AI. CTA measurement indicates the patient is suitable for TAVR. The patient’s STS PROM risk for redo SAVR is 2.97%. Heart Team evaluation deemed the patient high risk for surgery and appropriate for TF TAVR. Now planned for TF valve in valve TAVR via right percutaneous femoral arterial access using 26 mm Evolut FX valve after balloon valve fracture using a 23 mm True Balloon, with Sentinel cerebral embolic protection device in place.
