New York Transcatheter Valves Case1 Operators Samin K

New York Transcatheter Valves Case#1 Operators: Samin K Sharma, MD, FACC, MSCAI Annapoorna Kini, MD, MRCP, FACC Gilbert Tang, MD, MSc, MBA, FACC Sahil Khera, MD, MPH, FACC Parasuram Krishnamoorthy, MD Echocardiographer: Stamatios Lerakis, MD, Ph. D, FACC, FAHA Moderator: Roxana Mehran, MD, FACC, FAHA, FSCAI

Disclosures Samin K. Sharma, MD, FACC Speaker’s Bureau – BSC, Abbott Vascular Inc, CSI Annapoorna S. Kini, MD, FACC Nothing to disclose Gilbert Tang, MD, MSc, MBA, FACC Physician Proctor and consultant for Medtronic, consult for Abbott, W. L. Gore & Associates Roxana Mehran, MD, FACC. Moderator Nothing to disclose

NY Transcatheter Valves Case 1: CA, 91 y/o F Presentation: Worsening dyspnea on exertion, NYHA class III symptoms PMH: Hypertension, Hyperlipidemia, Type 2 Diabetes, Osteoarthritis, Osteoporosis, and Total knee arthroplasty Medications: ASA, Irbesartan, Amlodipine, Januvia, Metoprolol succinate, atorvastatin, Ferrous sulfate, Multivitamins, Calcium citrate Labs (11/09/2020): Hemoglobin 12. 3, K 4. 6, Plt 202, Cr 1. 14 EKG (11/09/2020): NSR with RBBB and LAFB, PR- 142 msec Nuclear Stress (10/21/2020): Mild inferoseptal and inferolateral ischemia and mild to moderate inferoposterior scarring versus attenuation artifact TTE (11/09/2020): LVEF 69%, Severe calcified AS with AVA/PG/MG/PV of 0. 9 cm 2 /49 mm. Hg/24 mm. Hg/3. 5 m/s, mild to moderate AI, mild to moderate MR, normal RV size and function, moderate pulm HTN

TTE Severe Calcified Aortic Stenosis Severe AS (PG/MG/AVA = 49/24/0. 9) AV Peak velocity = 3. 5 m/s

CTA: Aortic Annulus and LVOT Max: 26. 4 mm Min: 21. 4 mm Mean: 23. 9 mm Perimeter = 74. 5 mm Area = 428 mm 2 LVOT- Moderate to severe calcium Max: 24. 4 mm Min: 17. 2 mm Mean: 20. 8 mm Perimeter = 65. 5 mm Area = 321 mm 2 Annulus: 26. 4 x 21. 4 mm Area: 428 mm 2 Perimeter: 74. 5 mm LVOT: 24. 4 x 17. 2 mm Area: 321 mm 2 Perimeter: 65. 5 mm

CTA: SOV, STJ, Root angle, Coronary Ostia Sinus of Valsalva RCC = 29. 7 mm LCC = 30. 8 mm NCC = 31. 5 mm STJ Height (above annulus) = 30. 2 mm STJ Diameter = 31. 0 x 29. 3 mm (mean 30. 2 mm) STJ 31. 0 x 29. 3 mm RCC: 29. 7 SOV Height = 21. 8 mm Root angle = 45 LM Height: 13 mm LCC: 30. 8 NCC: 31. 5 Left Main: 13 mm

CTA - Femoral Arterial Access Longitudinal View Right Iliac/Femoral anatomy Longitudinal View Left Iliac/Femoral anatomy

CTA- Aortic arch

Medtronic Evolut- Pro+ Patient Selection Our Patient Annulus Max: 26. 4 mm Min: 21. 4 mm Mean: 23. 9 mm Perimeter = 74. 5 mm SOV Height = 21. 8 mm

Summary of Case Presentation: 91 year old female with NYHA Class III DOE TTE: LVEF 69%, Severe calcified AS with AVA/PG/MG/PV of 0. 9 cm 2/49 mm. Hg/24 mm. Hg/3. 5 m/s, mild to moderate AI, mild to moderate MR STS risk mortality: 5. 49% Course: Patient was evaluated by Heart Team and determined to be extreme risk for surgical AVR due to aortic root/LVOT anatomy, frailty and associated medical comorbidities Plan: The patient is here for TF- TAVR using 29 mm Evolut Pro + Core valve via left femoral percutaneous femoral access and possible sentinel protection device.