Prosthetic Aortic Valve Endocarditis Research Articles

Treatment of Late Infective Prosthetic Endocarditis Complicated by Cerebral Infarction with Vegetations: Pharmacotherapeutic Approach (Case Report)

Prosthetic endocarditis is a serious complication in a long term. Vegetation as a thromboembolic complication leads to neurologic deficit varying in severity.
 Case description. A 35-year-old female patient F. underwent surgical treatment at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery on September 07, 2016: aortic valve replacement with wrapping tape operation II. The patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition. On November 20, 2019, the patient was admitted to the Institute with the diagnosis of late infective prosthetic aortic valve endocarditis, status post aortic valve replacement and wrapping tape operation in 2016, first-degree atrioventricular block, cerebral infarctions in multiple locations with hemorrhagic transformation, with aphasia elements, ataxia, right-sided pyramidal insufficiency and suspected meningitis. After 21 days of drug therapy, the patient responded to treatment successfully and was discharged from the hospital in a satisfactory condition without surgical treatment.
 Conclusions. Taking into consideration the serious condition of the patient, timely and carefully selected drug therapy can be the correct solution for the treatment of patients with late infective endocarditis. Thus, surgery is not always the treatment of choice.

A customized technique for confluent aortic annular and selective sinus of Valsalva endocarditis.

We describe a novel technical modification for reoperative aortic valve replacement in destructive recurrent prosthetic aortic valve endocarditis. We encountered complex anatomy in a previously operated aortic root wherein the aortic annulus and the right coronary sinus of Valsalva were destroyed. This precluded secure suture placement. We modified a composite mechanical Valsalva conduit to create a separate sinus of Valsalva left in continuity with the mechanical valve. This approach allowed us to exclude the infected right sinus of Valsalva and the corresponding aortic annulus.

Prosthetic Aortic Valve Endocarditis With Extensive Para-Aortic Abscess: The Relevance of Multimodal Imaging

Prosthetic Aortic Valve Endocarditis With Extensive Para-Aortic Abscess: The Relevance of Multimodal Imaging

Three Decades of Experience with Aortic Prosthetic Valve Endocarditis.

The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male and 29 female, aged 67 ± 12 years, underwent surgery for a-PVE at our institution between 1994 and 2021. Median time from the original cardiac surgery was 1.9 [0.6-5.6] years, and 47 (33%) patients developed an early a-PVE. Of these patients, 73 (51%) underwent aortic valve replacement (AVR) with a biological or mechanical PAV, 12 (8%) underwent aortic root replacement (ARR) with a biological or mechanical PVC, and 59 (42%) underwent AVR or ARR with a CAH. Patients treated with a CAH had significantly more circumferential annular abscess multiple valve involvement, longer CPB and aortic cross-clamping times, and needed more postoperative pacemaker implantation than patients treated with a PAV. No difference was observed in survival, reoperation rates, or recurrence of IE between patients treated with a PAV, a PVC, or a CAH. CAHs are technically more demanding and more often used in patients who have extensive annular abscess and multiple valve involvement. However, the use of CAH is safe in patients with complex a-PVE, and it shows excellent early and long-term outcomes.

Reoperative aortic root replacement for prosthetic aortic valve endocarditis: impact of aortic graft.

Existing aortic graft complicates the surgical management of prosthetic valve endocarditis (PVE); yet, its impact has not been well studied. We compared outcomes of patients with prior aortic valve replacement (AVR) versus aortic surgery plus AVR, who underwent reoperative aortic root replacement (ARR) for PVE of the aortic valve. All patients who underwent reoperative ARR for PVE between 2004 and 2021 from 2 aortic centres were included. Two groups were formed based on the presence/absence of aortic graft: prior aortic surgery (AO) and prior AVR (AV) alone. Inverse propensity treatment weighting matched the groups. The Kaplan-Meier method was used to analyse long-term survival, and Fine and Gray model was used to compare the cumulative incidence of reoperation. A total of 130 patients were included (AO n = 59; AV n = 71). After matching, AO patients had increased stroke incidence (12.4% vs 0.9%) and renal failure requiring dialysis (11.5% vs 2.5%). In-hospital mortality was comparable (21.5% AO and 18.6% AV). Survival over 5 years was 68.9% (56.6-83.8%) in AO and 62.7% (48.1-81.7%) in AV (P = 0.70). The cumulative incidence of reoperation was similar [AO 6.3% (0.0-13.2%) vs AV 6.1% (0.0-15.1%), P = 0.69]. Reoperative ARRs for prosthetic valve/graft endocarditis are high-risk procedures. AO patients had higher incidence of postoperative morbidity versus AV patients. For all patients surviving operative intervention, survival and reoperation rates over 5 years were comparable between groups.

C55 A GIANT PSEUDOANEURYSM OF MITRAL–AORTIC INTERVALVULAR FIBROSA PRESENTING AS RECENT–ONSET ANGINA AND CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION

Abstract A 66–year–old man was suddenly referred to the emergency department (ED) for an extra–hospital cardiac arrest due to ventricular fibrillation, promptly treated by a single DC shock. Four months prior, he had undergone aortic valve replacement with a biological valve prosthesis (BVP, Perimount Magna n. 23) for severe aortic stenosis. One month after cardiac surgery the patient was hospitalized for acute cholecystitis requiring antibiotics and percutaneous cholecystostomy. On arrival to the ED the patient was awake and completely asymptomatic; no fever during days before the episode. He had been complaining of constricting retrosternal chest pain during physical exertion for ten days. However, no signs of ischemia were seen on the EKG. TT echo showed a very large pulsatile anaechogenic area posteriorly to BVP. Transesophageal echocardiography (TEE 2D, Traditional 3D and TrueVue) highlighted a very large pseudoaneurysm of mitral–aortic interventricular fibrosa (P–MAIVF; Figures 1 and 2, long axis and short–axis views). TEE features included: 1) a very large cavity with thickened walls, extended for more than two–thirds of the prosthetic circumference and with multiple septa; 2) a large communication between the left ventricular outflow tract (LVOT) and P–MAIVF (see yellow dotted line in Fig.1A) with a to–and–fro flow into the cavity and a prominent systolic pulsation; 3) no paraprosthetic leak and absence of any attached mass or intraprosthetic aortic regurgitation. These findings suggested a prosthetic aortic valve endocarditis with an extensive periannular involvement. Moreover, the P–MAIVF may have led to “ab extrinseco” compression of the left coronary artery, with a potential role in the genesis of chest pain and ventricular arrhythmia (in absence of significant CAD at preoperative coronary angiography). An empiric antibiotic therapy with daptomycin and piperacillin–tazobactam was started. The patients subsequently underwent Bentall surgery with a subannular implantation technique (Perimount valvular prosthesis n.23 and Gelweave vascular prosthesis n.28). Figure 3 shows an intraoperative image and postoperative TEE. In conclusion, P–MAIVF is an ominous complication of prosthetic valve endocarditis. Presentation with exertional angina and cardiac arrest is unusual. TEE is sensitive for diagnosis and 3D echo provides better insights into the anatomy helping formulate an appropriate surgical strategy.

18F-FDG-Based Radiomics and Machine Learning: Useful Help for Aortic Prosthetic Valve Infective Endocarditis Diagnosis?

BackgroundFluorine-18 fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) results in better sensitivity for prosthetic valve endocarditis (PVE) diagnosis, but visual image analysis results in relatively weak specificity and significant interobserver variability. ObjectivesThe primary objective of this study was to evaluate the performance of a radiomics and machine learning–based analysis of 18F-FDG PET/CT (PET-ML) as a major criterion for the European Society of Cardiology score using machine learning as a major imaging criterion (ESC-ML) in PVE diagnosis. The secondary objective was to assess performance of PET-ML as a standalone examination. MethodsAll 18F-FDG-PET/CT scans performed for suspected aortic PVE at a single center from 2015 to 2021 were retrospectively included. The gold standard was expert consensus after at least 3 months’ follow-up. The machine learning (ML) method consisted of manually segmenting each prosthetic valve, extracting 31 radiomics features from the segmented region, and training a ridge logistic regressor to predict PVE. Training and hyperparameter tuning were done with a cross-validation approach, followed by an evaluation on an independent test database. ResultsA total of 108 patients were included, regardless of myocardial uptake, and were divided into training (n = 68) and test (n = 40) cohorts. Considering the latter, PET-ML findings were positive for 13 of 22 definite PVE cases and 3 of 18 rejected PVE cases (59% sensitivity, 83% specificity), thus leading to an ESC-ML sensitivity of 72% and a specificity of 83%. ConclusionsThe use of ML for analyzing 18F-FDG-PET/CT images in PVE diagnosis was feasible and beneficial, particularly when ML was included in the ESC 2015 criteria. Despite some limitations and the need for future developments, this approach seems promising to optimize the role of 18F-FDG PET/CT in PVE diagnosis.

Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic Valve Endocarditis.

Invasive coronary angiography (ICA) is essential to detect significant coronary artery disease (CAD) but is generally not recommended in patients with infective aortic valve endocarditis. This study aimed to evaluate the risks and benefits of preoperative ICA in patients before aortic valve replacement. Between March 2008 and September 2020, 232 patients were surgically treated for infectious endocarditis of the aortic valve. Sixty-seven (29%) of them underwent preoperative diagnostic ICA and were compared with the patients without preoperative ICA. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the ICA data. The intraoperative data and clinical outcomes after ICA and after surgery were evaluated. ICA revealed a CAD in the majority of our patients (n = 36; 54%): One-vessel disease n = 19 (28%), two-vessel disease n = 6 (9%), and three-vessel disease n = 11 (16%). We observed no adverse events following preoperative diagnostic ICA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischemia were detected. During surgical aortic valve replacement, concomitant coronary artery bypass grafting was performed in 20 patients (30%). In patients with preoperative ICA, postoperative in-hospital mortality was significantly lower (n = 8 [12%] vs. n = 30 [18%]; p < 0.001), while the incidence of postoperative bleeding was higher (n = 18 [27%] vs. n = 22 [13%]; p = 0.022). The new-onset stroke incidence was 5% in each group. Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications.

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era.

Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

Evaluation of a rapid deployment prosthesis strategy for the treatment of aortic valve endocarditis.

The aim of this study was to evaluate the surgical outcome of patients suffering from native aortic valve (NVE) or prosthetic aortic valve endocarditis (PVE) treated with the EDWARDS INTUITY Elite rapid-deployment valve prosthesis. Between February 2019 and June 2020, 25 patients suffering from NVE (n = 9; 36%) and PVE (n = 16; 64%) of the aortic valve received an INTUITY valve at our institution. Preoperative, operative and follow-up data were collected. In our cohort, the mean EuroSCORE II was 13.4%. Eleven patients (44%) received concomitant aortic root patch plasty. Four patients (16%) received coronary artery bypass graft surgery, 3 patients (12%) received mitral valve repair and 2 patients (8%) underwent replacement of the ascending aorta. The cardiopulmonary bypass and aortic cross-clamp times were 124 ± 56 and 75 ± 39 min, respectively. The mean intensive care unit stay was 5 days. The mean size of the implanted prostheses was 25 ± 2 mm and the mean prosthesis transvalvular gradient 3 months after surgery was 9 ± 4 mmHg. During follow-up, no case of recurrent endocarditis occurred, 1 patient died of multisystem organ failure which had already been present preoperatively. Surgery for NVE and PVE of the aortic valve may be safely performed using the EDWARDS INTUITY Elite valve system. This procedure could be well implemented in cases with extensive infection, fragile root tissue and root abscesses requiring root reconstruction. In our institution, the rapid-deployment aortic valve replacement strategy has become an important tool in the armamentarium of the surgical endocarditis treatment.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

Achromobacter xylosoxidans Subspecies denitrificans Endocarditis in a Patient with Prosthetic Aortic Valve: A Case Report and Review of Literature

Achromobacter xylosoxidans subspecies denitrificans flourishes in presence of oxygen, commonly isolated from aquatic milieu. It is rarely implicated as the causative agent of endocarditis. It is not known to cause virulent infections in patients but causes severe infections in immunosuppressed patients with underlying co-morbidities. Present report is first case of Achromobacter xylosoxidans prosthetic valve endocarditis from India. This case report accounts for a 47-year-old man, suffering from Rheumatic Heart Disease (RHD), who presented to the cardiology emergency with chief complaints of remitting type high-grade fever for years years followed by persistent fever for 10 days. On echocardiography and positively flagged BACTEC blood culture reports was diagnosed as a case of Achromobacter xylosoxidans subspecies denitrificans bacteraemia and prosthetic aortic valve endocarditis. Antibiotics were started according to the susceptibility testing but the patient could not complete the course of treatment as he developed dyspnoea and cardiac arrest following which he could not be resuscitated.

Aortic Prosthetic Valve Endocarditis: Analysis of The Society of Thoracic Surgeons Database

BackgroundThis study sought to characterize the current US experience of aortic prosthetic valve endocarditis (PVE) compared with native valve endocarditis (NVE). MethodsThe Society of Thoracic Surgeons Database was queried for entries of active aortic infective endocarditis (IE). Two analyses were performed: (1) trends of surgical volume and operative mortality (2011-2019); and (2) descriptive and risk-adjusted comparisons between PVE and NVE (2014-2019) using multivariable logistic regression. ResultsFrom 2011 to 2019, there was a yearly increase in the proportion of PVE (20.9% to 25.9%; P < .001) with a concurrent decrease in operative mortality (PVE, 22.5% to 10.4%; P < .001; NVE, 10.9% to 8.5%; P < .001). From 2014 to 2019, active aortic IE was identified in 9768 patients (NVE, 6842; PVE, 2926). Aortic root abscess (50.1% vs 25.2%; P < .001), aortic root replacement (50.1% vs 12.8%; P < .001), homograft implantation (27.2% vs 4.1%; P < .001), and operative mortality (12.2% vs 6.4%; P < .001) were higher in PVE. After risk adjustment, PVE (odds ratio [OR], 1.5; 95% CI,1.16-1.94; P < .01), aortic root replacement (OR, 1.49; 95% CI,1.15-1.92; P < .001), Staphylococcus aureus (OR, 1.5; 95% CI,1.23-1.82; P < .001), and unplanned revascularization (OR, 5.83; 95% CI,4.12-8.23; P < .001) or mitral valve surgery (OR, 2.29; 95% CI,1.5-3.51; P < .001) correlated with a higher operative mortality, whereas prosthesis type (P = .68) was not an independent predictor. ConclusionsIE in the United States has risen over the past decade. However, operative mortality has decreased for both PVE and NVE. PVE, extension of IE requiring aortic root replacement, and additional unplanned surgical interventions carry an elevated mortality risk. Prosthesis selection did not affect operative mortality.

Fungal endocarditis after type a dissection, a positive outcome from Candida parapsilosis prosthetic aortic valve endocarditis and aortic graft infection: A testament to multidisciplinary practice

• Fungal endocarditis is increasing in prevalence and remains challenging to manage both acutely and in the chronic phase. • Dual anti-fungal therapy and timely operative management are the mainstays of effective treatment. • A prolonged multidisciplinary approach is important in managing these complex patients. Fungal endocarditis is associated with a very poor prognosis (mortality in excess of 50%) and the incidence is increasing due, in part, to the increased implantation of intra-cardiac devices and valve replacements. Diagnosis and treatment remain challenging, with the need for prolonged courses of dual, parenteral anti-fungal therapy that have several drug-drug interactions and side effects that require protracted monitoring. Moreover, there is uncertainty on the optimal management strategy for fungal endocarditis as, given its rarity, much of the evidence comes from small observational studies. We report a case of Candida parapsilosis prosthetic valve endocarditis and aortic graft infection necessitating a high-risk redo aortic valve replacement. This case illustrates the important role of the multidisciplinary Endocarditis Team in achieving a good outcome, despite year-long treatment and geographical separation of patient from the regional centre and Endocarditis Team expertise.

Coronary angiography in patients with native or prosthetic aortic-valve endocarditis: outcomes and implications for myocardial revascularisation

Abstract Background Coronary angiography (CA) remains the cornerstone of the preoperative assessments before open-heart surgery to detect or rule out coronary artery disease (CAD). Preoperative CA is currently not recommended in patients with active infective aortic valve endocarditis, but may help to reduce the risk of perioperative myocardial infarction. Purpose This study aimed to evaluate the risks and benefits of preoperative CA in selected patients before aortic valve replacement to treat active infective endocarditis of the aortic valve and to assess the incidence and relevance of CAD. Methods Sixty-five patients with native or prosthetic aortic-valve endocarditis underwent preoperative diagnostic CA between 03/2008 and 09/2020. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the CA data. We evaluated the intraoperative data, and clinical outcomes after CA and after surgery. Patients were selected according to the site, size and mobility of vegetations of the underlying active infective process. Results CA revealed CAD in the majority of patients (n=34; 52%): one-vessel disease n=17 (26%), two-vessel disease n=6 (9%), and three-vessel disease n=11 (17%). Coronary sclerosis without hemodynamic significance were detected in 23 patients (35%). Sixteen patients had a previous history of CAD. We observed no adverse events following preoperative diagnostic CA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischaemia. Surgery was performed 3 [IQR 1; 5] days after CA. During surgical aortic-valve replacement, concomitant coronary artery bypass grafting was performed in 19 patients (29%). Postoperative in-hospital mortality was 12% (n=8) and the new-onset disabling-stroke incidence was 2% (n=1). Neither stroke nor visceral or lower body ischemia due to embolism were observed in any patient after surgery. Conclusions By weighing risks and benefits of CA together as a team, no adverse clinical outcomes but significant clinical implications could be identified in patients with active infective aortic valve endocarditis. Concomitant surgical myocardial revascularization was frequent and may well have contributed to favorable clinical outcome. Therefore, active infective endocarditis of the aortic valve per se should not be regarded as an absolute contraindication for CA. Funding Acknowledgement Type of funding sources: None.

An alternative approach for complicated prosthetic aortic valve endocarditis

BackgroundSurgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands.Case presentationHerein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient underwent removal of the dehisced prosthetic valve, radical annular debridement, reconstruction of the aortomitral curtain with a pericardial patch as a patch exclusion technique and implantation of a sutureless valve.ConclusionPatch exclusion technique, followed by sutureless valve implantation, might represent a feasible and safe alternative for the surgical treatment of complicated PVE.

Re-interventions after the Ross procedure: reasons, technical approaches, immediate outcomes

Re-interventions after pulmonary autograft aortic valve replacement (Ross procedure) may be associated with dysfunction of the neoaortic, neopulmonary, or both operated valves. Late dysfunction, other than infective endocarditis, is associated with underlying conditions, technical errors, and unsuitable pulmonary trunk replacement materials. Re-interventions are technically complex, while tactical approaches have not been definitively formulated. Objective: to analyze re-interventions in patients after Ross procedure, technical approaches and immediate outcomes. Material and methods. Between 2001 and 2019, 14 patients were reoperated upon within 2 days to 21 years after primary Ross procedure. Early prosthetic endocarditis (2) and technical errors (1) were the reasons for early postoperative re-intervention. Neoaortic valve insufficiency (7), including pulmonary valve dysfunction (2), pulmonary valve degeneration (2), pulmonary prosthetic valve endocarditis (1), aortic, pulmonary and mitral valve endocarditis (1) were the reasons for late postoperative re-intervention. Based on the lesion volume, neoaortic valve replacement (3), neoaortic root replacement (6), including pulmonary valve/trunk replacement (8), and pulmonary trunk stenting (2) were performed. Results. In-hospital mortality was 7.1%. One patient died of early endocarditis after primary procedure. The postoperative period for the remaining patients was uneventful. Microscopic examination of the neoaorta revealed fragmentation of elastic fibers and rearrangement of tissue histoarchitectonics. In the pulmonary position, the aortic allograft and stentless xenograft had severe calcification and valve stenosis. Conclusions. Neoaortic valve insufficiency associated with cusp prolapse and neoaortic root dilatation may be the reasons for re-interventions after the Ross procedure. The second reason for re-interventions is valve graft dysfunction in the pulmonary trunk position. Elective reoperations on the neoaortic root and/or lung graft, despite the large volume, can be performed with low mortality and morbidity. Aortic allografts and xenografts for reconstruction of the right ventricular outflow tract (RVOT) is unjustified due to early and more severe dysfunction compared to pulmonary allograft.

Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic-Valve Endocarditis – Outcomes and Implications for Myocardial Revascularisation

Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic-Valve Endocarditis – Outcomes and Implications for Myocardial Revascularisation

A modified technique for aortic prosthesis implantation after prosthetic valve endocarditis complicated by complex paraannular aortic abscess.

The aim of this study is to describe a modified technique for aortic prosthesis implantation in the sinuses of Valsalva without the use of a patch for aortic annular reconstruction in patients with prosthetic valve endocarditis complicated by aortic abscess. From January 2008 to March 2021, 47 patients underwent aortic valve replacement due to prosthetic aortic valve endocarditis. The new aortic prosthesis was implanted into the sinuses of Valsalva above the abscess left open to drain. The first step consists in passing U-shaped stitches with pledgets through the aortic wall approximately 5-7 mm above the abscess involving the annulus. In the second step, the prosthesis is fixed to the aortic wall. In the third step, a 10 mm wide Teflon strip is positioned along the external course of the aortic wall and U-shaped stitches without pledgets are passed from the outside to the inside to definitively fix the prosthetic annulus to the sinuses of Valsalva. In-hospital mortality was 8.5% (4/47 patients). Mean follow-up was 62 ± 37.7 months. Four patients died (9.3%). Predicted probability of cardiac vs non-cardiac mortality was not statistically significant (p = 0.88). Overall survival probability (freedom from all-cause death) at 3, 7 and 9 years was 97%, 87.5% and 75%, respectively. No patients presented with grade 2 or 3 peri-prosthetic leak, nor had endocarditis. Prosthetic valve endocarditis complicated by complex paraannular aortic abscess can be successfully addressed with good long-term results by using our alternative technique.

Subacute Prosthetic Aortic Valve Endocarditis Causing Syncope due to Left Ventricular Outflow Tract Obstruction

Infective endocarditis is not typically associated with symptoms of left ventricular outflow tract (LVOT) obstruction.