CASE:

85-year-old male presents with worsening shortness of breath, leg edema and with a recent history of hospitalization due to CHF exacerbation. Past medical history is significant for hypertension, hyperlipidemia, CAD s/p CABG x4 (2004), s/p multiple PCIs (most recently on 6/17/2022 and 7/26/2022 to LCX-OM1 and SVG-RCA respectively), nonrheumatic MV regurgitation s/p MVR with a 27 mm Hancock II valve through left posterolateral thoracotomy (2/3/2010), Afib on Coumadin, and h/o LAA thrombus.

A recent TEE on 6/15/22 revealed degenerative mitral valve bioprosthesis with flail leaflets and severe MR, with systolic flow reversal present in the pulmonary vein flow pattern, the mean mitral valve gradient through the prosthesis was 7 mmHg with no evidence of LAA thrombus and EF of 40%. 

CTA measurement indicated that the patient is suitable for trans-femoral (TF) valve-in-valve TMVR. The patient’s STS PROM risk for redo surgery is 4.5%. Heart team evaluation deemed the patient at high risk for 3rd re-operative surgery and appropriate for TF-TMVR. Now is being planned for TF valve-in-valve TMVR via right percutaneous femoral vein access using 23 mm + 2cc Sapien-3 Ultra valve.