TAVR via Percutaneous Femoral Access for Advanced Age, Extreme Risk AVR Patient

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TAVR via Percutaneous Femoral Access for Advanced Age, Extreme Risk AVR Patient

By Mount Sinai Structural Heart Live Cases FEATURING Samin Sharma, Annapoorna Kini

580 views

May 23, 2016

Case and Plan:

An 88 year-old female presented with progressive shortness of breath – NYHA ...
read more ↘ class III, with a history of hypertension, chronic diastolic HF, COPD and s/p BAV on 7/2/15. TTE revealed severe AS, peak/mean aortic gradient = 65/44 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4 m/sec and LVEF 65%. CT angio showed minimum diameters of 0.4 x 0.7 cm for right and 0.6 x 0.6 cm for the left common femoral arteries and aortic annulus of 2.5 x 2.1 cm (average 2.3). The STS risk mortality is 5.15 and the Logistic Euroscore mortality is 12.81. Patient was determined to be extreme risk for surgical AVR due to advanced age and marked, generalized frailty. Patient is now planned for CoreValve Evolut R TAVR (26mm) via percutaneous femoral access under conscious sedation.
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