Structural Heart Live Cases

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Presentation transcript:

Structural Heart Live Cases Supported by: Medtronic inc Bard Inc Terumo Medical Corp

Disclosures Samin K. Sharma, MD, FACC Speaker’s Bureau – Boston Scientific Corp., Abbott Vascular Inc, ABIOMED, CSI Annapoorna S. Kini, MD, FACC Nothing to disclose Gilbert Tang, MD Physician proctor for Medtronic George Dangas, MD

September 11th 2018- Structural Heart Live Case: TC, 87 yo F Presentation: Severe dyspnea on exertion NYHA Class III x 3 months PMH: Bioprosthetic MVR (25mm Medtronic Mosaic Porcine) and TV Repair (26mm Medtronic Tri-Ad Annuloplasty ring) in May 2014, Thrombocytosis (Platelet >1000K), Atrial Fibrillation on Coumadin, Hypertension, hyperlipidemia, Stage III CKD Medications: Coumadin, Amiodarone, Simvastatin, Ramipril, Anagrelide, Letrozole Labs: Hgb 9.2, PLT 1052, K 4.2, Cr 1.5, INR 1.9 EKG (8/28/18): NSR, IVCD (QRS 118ms) TTE (8/24/18): EF 64%, minimal MR, mild to moderate TR, severe AS (PG/MG/AVA = 52/37/0.92), mild to moderate AR Cath (8/28/18): Normal coronaries

Severe AS (PG/MG/AVA = 62/42/0.9) Severe Aortic Stenosis TTE Severe AS (PG/MG/AVA = 62/42/0.9) AV Peak velocity = 3.9 m/s Severe Aortic Stenosis

CTA: Aortic Annulus Aortic Annulus Max: 26.2 mm Min: 19.8 mm Mean: 23 mm Perimeter = 71.7 mm Area = 392.7 mm2 Annular angle = 42° Annulus: 19.8x26.2 mm Area: 392.7 mm2 Perimeter: 71.7 mm Annulus Angle: 42°

CTA: SOV, STJ, Coronary Ostia Sinus of Valsalva RCC = 30.2 mm LCC = 33.4 mm NCC = 31.5 mm STJ height (above annulus) = 20.6 mm STJ = 28.5 x 28.9 mm (mean 28.7 mm) LVOT = 17.3 x 23.1 mm (mean 20.2 mm) Ascending aorta = 31.7 x 32.4 mm (mean 32 mm) RCC: 30.2 LCC: 33.4 NCC: 31.5 LM: 9.5 mm LCA: 13.5mm RCA: 17.3mm

Femoral Arterial Access 8.2x10.5mm 10.2x11.3mm 7.0x8.3 7.8x8.1mm 8.3x9.6 7.8x7.9mm Longitudinal View Right Iliac/Femoral Anatomy Longitudinal View Left Iliac/Femoral Anatomy Access 3D

Great Vessel Anatomy for Cerebral Protection Device Consideration LAO: 15° Cranial: 5° Right Innominate Diameter = 10.6 mm Left Common Carotid = 6 mm

Medtronic Evolut-PRO Patient Selection Patient CTA Findings Annulus: Max: 26.2 mm Min: 19.8 mm Mean: 23 mm Perimeter = 71.7 mm Area = 392.7 mm2 STJ= 28.5 x 28.9mm

Summary of Case Presentation: 87 year old female with NYHA Class III DOE TTE: EF 64%, severe aortic stenosis (PG/MG/AVA = 62/42/0.9), mild to moderate AR STS risk mortality: 7.24 % EuroScore II risk: 13.62% Logistic Euroscore mortality: 27.25% Course: Patient was evaluated by Heart Team and due to her multiple co-morbidities and frailty status, the patient was determined to be High Risk for SAVR Plan: The patient is referred for TAVR with a 26 mm Medtronic Evolut-Pro Corevalve via transfemoral access (right percutaneous) with possible Sentinel cerebral protection.