Emergency valve‐in‐valve transcatheter aortic valve implantation for endocarditis degeneration

Abstract

The use of transcatheter aortic valve implantation (TAVI) in the emergency setting has not been widely reported, and TAVI is generally contraindicated in the context of endocarditis. Here we describe a patient developing acute cardiogenic shock due to prosthetic aortic valve degeneration with free‐flow aortic regurgitation 8 months after receiving treatment for confirmed infective endocarditis. Due to his clinical status, he was deemed unfit for redo surgery, and he underwent salvage valve‐in‐valve (ViV)‐TAVI. The patient made an excellent recovery. Postprocedure he was treated with a 6‐week course of antibiotics, and at 18‐months follow‐up remains very well with no evidence of reinfection. This case may demonstrate that for selected patients with degenerative prosthetic aortic valve disease, despite a history of infective endocarditis, ViV‐TAVI may be considered an alternative to redo surgery in the emergency setting.

Emergency Transcatheter Aortic Valve Implantation in a Surgical Aortic Bioprosthetic Valve for Acute Decompensated Heart Failure Caused by Sudden Progression of Structural Valve Deterioration

“…Seven case reports on emergency TAV-in-SAV for SVD were published between 2013 and 2020 (5)(6)(7)(8)(9)(10)(11). These reports included 6 cases of severe AR, 1 of severe AS, 2 cardiac arrests, and 2 veno-arterial extracorporeal membrane oxygenation cases; all patients were in cardiogenic shock, and 5 were over 70 years old.…”

Percutaneous Aspiration (AngioVac) of a Mitral Valve Vegetation followed by a Transcatheter Mitral Valve-in-Valve Intervention

“…The initial AngioVac evacuation allowed safe implantation of the MViV prosthesis. Transcatheter aortic ViV implantation for aortic regurgitation secondary to bioprosthetic aortic valve endocarditis was reported by Fathi et al 9 They described a ViV transcatheter aortic valve implantation 8 months after treatment of infective endocarditis, and antibiotics were administered 6 weeks post procedure. The most common indications of ViV replacements include degenerated mitral prostheses, failed surgical rings, and severe mitral annular calcifications.…”

Anesthesia Considerations in Infective Endocarditis

“…216,217 Transcatheter aortic valve replacement is generally contraindicated in the context of endocarditis; however, it may still serve as a feasible option in exceptional or emergency cases. 218 There is a noticeable trend to be therapeutically more aggressive in patients with imminent risk of embolism 46 and increasing age. This increase in the number of high-risk patients will present cardiac surgeons and anesthesiologists with a challenge, especially in terms of decision-making.…”

“…216,217 Transcatheter aortic valve replacement is generally contraindicated in the context of endocarditis; however, it may still serve as a feasible option in exceptional or emergency cases. 218…”