Abstract
Implantation of Sutureless Aortic Valve in a High- Risk Patient with Active Infective Endocarditis TAVI
Highlights
Active infective endocarditis (AIE) is a serious septic risk for all patients, especially if prostheses in conventional aortic valve replacements (AVR) or transcatheter aortic valve implantation (TAVI) are afflicted [1]
Indications for urgent operative debridement and valve replacement in complicated cases of AIE that cannot always be managed with conventional appropriate antibiotic therapy such as embolisms, multi resistant- or atypical pathogens, including methicillin resistant staphylococcus aureus (MRSA) and fungi, recurring IE and acute heart failure [2,3]. This is in conflict with a fraction of the patient population at high or very high operative risk according to Euro SCORE II [4]
TAVI valves are at risk of AIE, leaving patients at a dead end concerning operative endocarditis treatment, as complicated courses of AIE need surgical decontamination and debridement before implanting a new valve [8,9,10]
Summary
J Cardiol & Cardiovasc Ther Copyright © All rights are reserved by Pascal Maria Dohmen. Active infective endocarditis (AIE) is major problem especially for patients with prior valve intervention or device implantation. We present a 77-year-old patient suffering from AIE 14 months after transcatheter-implanted aortic valve (TAVI). The heart team considerated TAVI by increased operative risk, Euro SCORE of 10.42%, including sever pulmonary hypertension, chronic obstructive pulmonary disease, insulin depending diabetes mellitus, chronic renal failure and polyneuropathy. During follow-up, the patient underwent dental treatment and afterwards developed 39°C fever und blood culture showed repeatedly Escherichia Coli. The heart team decided, a Euro SCORE of 63.57%, appropriate antimicrobial therapy in combination with surgery. A sutureless aortic valve was embed after annulus patch reconstruction. This case demonstrated that sutureless valves maybe a valuable option for AIE-TAVI treatment
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