Structural

Medstream360 members only

To view this video and learn more about the procedure please Login or Register.
Membership is free!

The Mount Sinai Hospital

1468 Madison Avenue, New York,
New York 10029

Valve in Valve TAVR with 26mm SAPIEN 3 - March 2019

TAVR valve-in-valve

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√ó25.7 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.

download

Case presentation

close

Lorem ipsum dolor sit amet consectetur adipisicing elit. A, dignissimos?