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

2. 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

3. 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

4. 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

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

6. 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

7. 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

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

9. 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 = mm2
STJ= 28.5 x 28.9mm

10. 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: %
EuroScore II risk: %
Logistic Euroscore mortality: %
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.