Simultaneous TAVR and TMVR Sachin S Goel MD, Waleed Alharbi MD, Vincent Zuck MD, Nilesh Goswami MD Structural Heart Program, Prairie Heart Institute St John’s Hospital, Springfield IL, USA June 21, 2018
Disclosure Statement of f Financial In Interest I, [Sachin Goel MD], DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
VR VR – 75 75 yr yr old Female, 162.6 .6 cm, , 75.3 .3 Kg • NYHA III-IV CHF, Admitted with NSTEMI, Acute CHF exacerbation, and hypotension with dialysis • Paroxysmal AFIB- Coumadin • CAD with h/o PCI • ESRD on dialysis • h/o embolic CVA • Anemia with GI bleed (AV malformations) • Diabetes- Insulin • Hypertension • Hyperlipidemia • Aortic Stenosis- low flow low gradient with SVI of 16.2 • Mitral Stenosis with mean gradient of 10 and moderately severe MR • STS: 26.82 • Surgical risk: high to prohibitive risk
Vmax 3.7 m/sec Mean AV gradient 32 mm Hg Mean mitral gradient 10 mm Hg
Annular Measurement Annulus by CT (Date) Measure Annular Perimeter 71.9 Annular Area 3.93 Valves #23 S3 (+3.3%) #26 Evolut R/PRO Comment:
Aortic Complex
Mitral Measurements #29 S3
Right Heart Catheterization and Coronary Angiogram RA: 24 mm Hg RV: 79/21 mm Hg PA: 78/40 (55) mm Hg PCWP: 40 mm Hg LV: 138/30 mm Hg Aorta: 100/62 mm Hg Low cardiac output
Access
TAVR/TMVR Summary Cath STS: 26.82 LCX Roto PCI, LAD PCI Key Risk Contributors: multiple comorbidities, ESRD on hemodialysis, Commercial: Edwards severe AS and MS, moderately depressed right ventricular function, and multiple Access: TF RIGHT TAVR/ mitral position CVA’s transseptal Planned Valve Size: Double valve procedure Echocardiography: with a #23 Edwards S3 in the aortic position AVA: 0.61 with the sentinel device followed by a #29 AV velocity: 2.79 Edwards S3 in the mitral position CT Annular Measurements: Date Procedure Planned: 3/22/18 Aortic Area: 3.93, Perimeter: 71.9 Mitral: 5.54 sq cm, Avg Dia 27 mm Echo: TEE Anesthesia: General
1 month follow up Echocardiogram
Conclusion • Successful case of TAVR and TMVR with balloon-expandable aortic valves in extreme surgical risk patient with severe AS and severe MAC with mitral stenosis and mitral regurgitation
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