1. Gates Vascular Institute
Emergent TAVR in a Failed Surgical Aortic Bioprosthesis Presenting in Cardiogenic Shock
Vijay Iyer MD PhD
Rose Hansen DNP
Gates Vascular Institute
Buffalo New York

2. Rose Hansen DNP I have no relevant financial relationships
I have no relevant financial relationships
Vijay Iyer MD PhD

3. Learning objectives Diagnosis of AR in C-Shock
TAVR VIV App Urgent Application
Feasibility of Emergent VIV TAVR for Cardiogenic shock

4. Clinical Presentation : 7/11/16 @1600 Outlying Facility Initial Trop 0
Clinical Presentation : Outlying Facility Initial Trop 0.1 CP resolved
Age: 52 year old Male
STS:41.8%/80%
NYHA Class IV
CAD, PCI to LAD2005
Combined : CABG 2 valves 2014
~ LIMA to Diag/SVG to RCA
~MV Repair Edwards Physio Annuloplasty
ring with Alfieri Suture
~ AVR Medtronic Freestyle 25mm
Labs
Creatinine= GFR=
WBC= PLT=
Hgb= HCT=
BNP= INR=1.1
Albumin= Bili=0.8
troponin 3.2
Rheumatoid arthritis, previously treated with
methotrexate
NIDDM
LBBB
Former smoker 35-pack-year history
Ht: 180cm
Wt: 88kg
BSA: 2.1
BMI:27.8
1600Pt presented with acute onset chest pain and shortness of breath while working.
Allergies: NKDA
Stable awaiting AM transfer for R&L
Summary:

5. Presenting EKG 7/11

6. Summary: 7/12/16 transferred to GVI for R&L Heart Cath
SOB, Decompensated Flash Pulmonary Edema requiring intubation while awaiting catheterization.
R&L revealed patent grafts, patent LAD. EF 50%. TEE revealed torn/flail aortic valve leaflet, severe aortic regurgitation.
TAVR TEAM was finishing a TAVR case when urgent call came for Surgeon.
Edwards Rep Onsite
Team prepped for TF TAVR with available information
Summary:

7. Native Left Coronary

8. Cath: LIMA/LAD

9. RCA

10. SVG to PDA

11. AortaGram

12. Pre TEE

13. Illiofemoral Runoff

14. VIV APP: 26mm Sapien3

15. Post TAVR deployment

16. Summary:
52-year-old with cardiogenic shock and aortic regurgitation in a bioprosthetic valve
Successful implantation of 26 mm Edwards Sapien 3 into a 25 mm Freestyle
Implantation of lmpella 2.5L for hemodynamic support × 24 hours
LBBB development
Transfer to CVICU
Perioperative CVA Per MRI with right foot drop
Discharged to home postop day 7
Right peroneal nerve compression improved
Return to light duty work in 2 weeks
30 day follow-up. No complaints chest pain or CHF. Drives.
Echo EF 45%, mean gr 15mmhg
Creat 0.8
LBBB resolved

17. 30 Day Post TAVR

19. Take Home Messages
Emergent TAVR can be done successfully in select cases
Valve in valve application proved invaluable
A well trained heart team can save lives and promote good outcomes.