Elderly people suffering from aortic valve stenosis often have history of Peripheral artery disease. At times they are turned down for the treatment of transcatheter aortic valve replacement, a minimally invasive percutaneous method of aortic valve replacement. Instead they are treated by more invasive approach such as transapical approach (puncturing the heart instead of a groin artery) at times. With the advent of technology and our expanded skills of treating periphral vascular disease as well as the structural heart disease at the same time allows us to treat patients without increasing the risk of procedure. An elderly patient with high STS risk score had Severe aortic valve stenosis & poor pumping of the heart (Ejection Fraction of 35%). The diagnosis was missed for a while. The patient was swollen. He had gained 35 lbs weight. over 3 months. It took two weeks of close care in hospital to remove 25 liter of water over 2 weeks. The challenging aspect was that he had previous placement of Iliac stents (Stent in the arteries above the Hip Joint near the belly button) on both sides. The stents were undersized and under expanded. This required addiltional expertise of endo-vascular procedures along with the skills to do structural heart procedures like TAVR. We used technology of intravascular Lithotrypsi blloon "shockwave" to crack the circumferential 360 degree calcium in the arterial wall.This technology allows to expand the artery without risking rupture of the artery. After further dilating the artery a 16 Fr Edward sheath (a large tube with outer diameter over 6.5 cm) was advanced very carefully to complete a percutaneous, minimally invasive, transcatheter aortic valve replacement as seen in the video. Patient was sent home the next day after valve replacement and now doing very good. see the video here:
Link to the publication by Dr. Sanghvi on this topic:
https://pubmed.ncbi.nlm.nih.gov/30121283/
