Successful subclavian transcatheter aortic valve replacement in a nonagenarian patient

Abstract

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.