Cardiovascular Institute

Cardiovascular Institute December 22, 2016

CME: Text

Holiday Absences: Dr Pearson out, Dr. Nazari out, Dr Fisher out, Dr. Metzler at HPH for case, Dr Guerreo out, Dr. Levisay and Dr. Russell late arrival

Follow up K, R 10/33 83 year old who underwent EtOH septal ablation 2/18/15 (2.5 cc with block/CPK 1200) for DOE. One year echo follow up….feels great and echo done

CoreValve Evolute R: Self expanding TAVR valve revisited F, N 73 year old sizing from TEE due to vascular access issues limiting CTA

When do self expanding valves make sense? Eight days Uncertain size or “in between/gray zone size” (more forgiving) Large and bulky calcium* Low coronaries (company says no low coronary exclusions) Small femorals (non expanding 14 F sheath less labeled 5.0 mm vessel) Large annulus (26 S3 goes 683) (34 mm Evolute R goes up to area 707 mm2) Subclavian advantage for tracking Question V in V application (company says “better” hemodynamics than S3)?? Undersized bicuspids??

*P, A 84 year old “underappreciated” calcium 26 S3

It was a myxoma K, B 70 year old found to have atrial mass

Intuit Valve K, G 79 year old CABG x 4, MAZE +AVR using Edwards Intuity Valve Potential reasons to use Intuity Save time (3 instead of 15 sutures) in long or complex cases Low EF 4 to 5% heart block About 2X cost Low gradient