The heart physicians at McLaren Northern Michigan performed a TAVR (transcatheter aortic valve replacement) which was aired in documentary format and streamed online Monday, February 24, 2014. After the procedure, a live Twitter Q&A event was hosted. Below you’ll find information about the event, along with the TAVR documentary video.
Our patient, Robert Miller, is an 82 year-old male with a history of coronary artery disease with three vessel bypass in 1994 and a two vessel redo in 1997. His three native coronary arteries are occluded and his only patent graft is a LIMA to the left anterior descending artery. He has severe ischemic cardiomyopathy with an ejection fraction of 25% and an ICD placed for secondary prevention, after an episode of sustained ventricular tachycardia. Other pertinent history includes: moderate mitral regurgitation, non-insulin dependent diabetes, stage III chronic kidney disease, chronic bronchitis and spinal stenosis.
He presented to our medical center last August with a syncopal episode. At that time he was found to have severe, low-flow, low-gradient AS with an aortic valve area of 0.4 cm and a peak velocity of 350 cm/sec. In March of 2013 he was hospitalized in Florida, where he winters, with decompensated systolic heart failure.
After completing our work-up, he was deemed inoperable by our two cardiothoracic surgeons. His STS score was 9.8 and ESII was 15.3. His aortic annulus was 513 mm. His left common iliac was 8.9 mm with 2 quadrant calcium. The external iliac was 9.8 cm with no calcification and the common femoral was 9.8 mm with minimal posterior calcification. There was an ulcerated plaque in the distal left common femoral artery encroaching on 50% of the lumen. His right common and external iliac arteries were under 8 mm, precluding us from using the right side.
The plan going into the case was for a percutaneous, transfemoral approach from the left groin with a 26mm Sapien XT valve. The case would not be converted to an open surgical procedure if problems arose.