Case 2
A 75-year-old female presented with a Porcelain Aorta and a long-standing history of severe, symptomatic aortic insufficiency, with a severely calcified aorta throughout, a calcium score of 5888, and diffuse aneurysmal dilation of the ascending aorta. She was deemed inoperable mostly because of frailty, severe pulmonary hypertension, and the associated Porcelain Aorta, and therefore consider for a TAVR procedure. A transthoracic echocardiogram prior to surgery showed adequate left ventricular systolic function with an ejection fraction of 60%, dilation of the left ventricle, severe aortic insufficiency, and severe pulmonary artery hypertension with right ventricular systolic pressure of 80 mmHg (Figure 3). Her aortic area was 452 mm2. The patient had a successful percutaneous right transfemoral TAVR with Medtronic 29 mm Evolut Pro valve implanted, followed by an Edwards SAPIEN 3, #26, -1 cc bioprosthetic valve deployment inside the first valve (Figure 4). At the end of this procedure, there was trace aortic insufficiency present and excellent hemostasis confirmed by transesophageal echocardiography.