Rationale:
In super-aged patients with severe symptomatic aortic stenosis, transcatheter aortic valve replacement (TAVR) is a good treatment option, and the number of TAVR-eligible elderly patients is expected to grow exponentially. We present the case of a nonagenarian woman with severe aortic stenosis who underwent successful subclavian TAVR.
Patient concerns:
A 90-year-old Korean woman was brought to our department with dyspnea. On physical examination, a grade IV systolic murmur was auscultated in both the upper sternal borders and the left lower sternal border.
Diagnosis:
A transthoracic echocardiogram showed heavy calcification of the aortic valve with an increase in both peak velocity (4.36 m/s) and mean pressure (44.8 mm Hg), indicating severe symptomatic aortic stenosis.
Interventions:
After a heart team conference involving interventional cardiologists, cardiac surgeons, and anesthesiologists, subclavian TAVR was performed. Using the left subclavian artery, we successfully deployed a self-expandable valve prosthesis (CoreValve
TM
Evolut R
TM
, Medtronic Inc., Minneapolis, MN).
Outcomes:
After TAVR, transthoracic echocardiogram showed a decline in both peak velocity (2.06–2.14 m/s) and mean pressure (7.42–7.95 mm Hg) with an increase in the aortic valve area (1.12 cm
2
). The patient's dyspnea symptoms improved dramatically.
Lessons:
In addition to femoral TAVR, subclavian TAVR may be feasible and safe in super-aged patients.