Case and Plan:
67-year-old female presents with worsening NYHA Class III symptoms of heart failure for the last 3 months. Past medical history significant for HTN, HLD, Afib s/p ablation in 2012 (no longer on anticoagulant), asthma, OSA (on CPAP), thrombocytosis, severe AS s/p AVR (ATS 3F valve) in 2012 and redo AVR (23 mm Magna Ease valve) with CABGx1 (LIMA to LAD) in 2015. Recent echocardiogram revealed LVEF of 55%, severe bioprosthetic aortic valve stenosis (PG/MG/AVA/PV: 92/60/0.91/4.8), mild AR, mild MR & mild TR. Her TEE showed severely degenerated aortic bioprosthesis with severe stenosis and moderate valvular AR and no paravalvular leak. Her STS PROM risk for second redo AVR is 5.2%. Heart Team evaluation recommended TF TAVR. Now planned for TF valve in valve TAVR via right percutaneous femoral arterial access using 23mm Sapien-3 Ultra valve with Sentinel cerebral embolic protection device.
