Prosthetic Valve Endocarditis after Transcatheter Aortic Valve Implantation Complicated by Paravalvular Abscess and Treated by Pericardial Patches and Sutureless Valve Replacement

  • Emilien Philippe Ruchonnet Cardiac Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • Aurélien Roumy Cardiac Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • Valentina Rancati Cardiac Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  • Matthias Kirsch Cardiac Surgery Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
Keywords: SYMETIS ACURATE neo™, TAVI endocarditis, Aortic valve fistula pericardial patch repair, Sutureless Perceval S

Abstract

Background: Endocarditis is a rare complication of transcatheter aortic valve implantation (TAVI), with an estimated 1-year incidence of 0.50% [Circulation 2015]. However, ensuing consequences are often dire, and its surgical treatment poses unique problems, due to the frequent underlying frailty of TAVI recipients.

Case Report: We report the case of an 84-year-old woman, who developed Staphylococcus aureus prosthetic valve endocarditis (PVE) 7 days after transfemoral TAVI (ACURATE neo™, Boston Scientific or Symetis, further complicated by an aortic annular abscess with fistulization into the right atrium. The patient underwent successful operative aortic annulus repair, using pericardial patches, and aortic valve replacement with a sutureless Perceval S bioprosthesis (LivaNova).

Conclusion: Our case documents the treatment of an active fistulizing Symetis ACURATE neo ™ prosthetic aortic valve endocarditis by using a sutureless LivaNova Perceval S prosthesis with satisfying hemodynamic results and an encouraging 1-year outcome, further corroborating its usefulness in such circumstances.

References

Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H, et al. 2015. Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry. Circulation 131(18):1566-74.

Gersak B, Fischlein T, Folliguet TA, et al. 2016. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 49(3):709-18.

Habib G, Lancellotti P, Antunes MJ, et al. 2015. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36(44):3075-128.

Husser O, Kim WK, Pellegrini C, et al. 2017. Multicenter comparison of novel self-expanding versus balloon-expandable transcatheter heart valves. JACC Cardiovasc Interv 10(20):2078-87.

Lio A, Miceli A, Solinas M, Glauber M. 2015. Initial experience with sutureless Sorin Perceval S aortic prosthesis for the treatment of prosthetic valve endocarditis. Thorac Cardiovasc Surg 63(6):501-3.

Perrotta S, Jeppsson A, Fröjd V, Svensson G. 2016. Surgical treatment of aortic prosthetic valve endocarditis: a 20-year single-center experience. Ann Thorac Surg 101(4):1426-32.

Roselló-Díez E, Cuerpo G, Estévez F, et al. 2018. Use of the Perceval sutureless valve in active prosthetic aortic valve endocarditis. Ann Thorac Surg 105(4):1168-74.

Weymann A, Konertz J, Laule M, Stangl K, Dohmen PM. 2017. Are sutureless aortic valves suitable for severe high-risk patients suffering from active infective aortic valve endocarditis? Med Sci Monit 23:2782-7

Published
2019-04-04
Section
Articles