Simultaneous TAVR and TMVR Sachin S Goel MD, Waleed Alharbi MD, - - PowerPoint PPT Presentation

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Feb 06, 2023 24 likes •217 views

Simultaneous TAVR and TMVR Sachin S Goel MD, Waleed Alharbi MD, Vincent Zuck MD, Nilesh Goswami MD Structural Heart Program, Prairie Heart Institute St Johns Hospital, Springfield IL, USA June 21, 2018 Disclosure Statement of f Financial In

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Simultaneous TAVR and TMVR

Sachin S Goel MD, Waleed Alharbi MD, Vincent Zuck MD, Nilesh Goswami MD Structural Heart Program, Prairie Heart Institute St John’s Hospital, Springfield IL, USA June 21, 2018

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Disclosure Statement of f Financial In Interest

I, [Sachin Goel MD], DO NOT have a financial interest/arrangement or affiliation with one or more

rganizations that could be perceived as a real or

apparent conflict of interest in the context of the subject of this presentation.

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VR VR – 75 75 yr yr old Female, 162.6 .6 cm, , 75.3 .3 Kg

NYHA III-IV CHF, Admitted with NSTEMI, Acute CHF exacerbation, and

hypotension with dialysis

Paroxysmal AFIB- Coumadin
CAD with h/o PCI
ESRD on dialysis
h/o embolic CVA
Anemia with GI bleed (AV malformations)
Diabetes- Insulin
Hypertension
Hyperlipidemia
Aortic Stenosis- low flow low gradient with SVI of 16.2
Mitral Stenosis with mean gradient of 10 and moderately severe MR
STS: 26.82
Surgical risk: high to prohibitive risk

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Vmax 3.7 m/sec Mean AV gradient 32 mm Hg Mean mitral gradient 10 mm Hg

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Annular Measurement

Annulus by CT (Date) Measure Annular Perimeter 71.9 Annular Area 3.93 Valves #23 S3 (+3.3%) #26 Evolut R/PRO Comment:

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Aortic Complex

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Mitral Measurements

#29 S3

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Right Heart Catheterization and Coronary Angiogram

RA: 24 mm Hg RV: 79/21 mm Hg PA: 78/40 (55) mm Hg PCWP: 40 mm Hg LV: 138/30 mm Hg Aorta: 100/62 mm Hg Low cardiac output

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Access

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STS: 26.82 Echocardiography: AVA: 0.61 AV velocity: 2.79 Commercial: Edwards Access: TF RIGHT TAVR/ mitral position transseptal Planned Valve Size: Double valve procedure with a #23 Edwards S3 in the aortic position with the sentinel device followed by a #29 Edwards S3 in the mitral position CT Annular Measurements: Aortic Area: 3.93, Perimeter: 71.9 Mitral: 5.54 sq cm, Avg Dia 27 mm Key Risk Contributors: multiple comorbidities, ESRD on hemodialysis, severe AS and MS, moderately depressed right ventricular function, and multiple CVA’s Date Procedure Planned: 3/22/18

TAVR/TMVR Summary

Echo: TEE Anesthesia: General Cath LCX Roto PCI, LAD PCI

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1 month follow up Echocardiogram

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Conclusion

Successful case of TAVR and TMVR with balloon-expandable aortic