Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Periapical subcutaneous siero-haematic collection and full-thickness anterior thoracic wall defect 18 months after transapical transcatheter aortic valve implantation (TA-TAVI) (n=1). Intervention: Surgical drainage, curettage, daptomycin antibiotic therapy, and chest wall reconstruction using an intercostal artery perforator (IAP) flap with fibrin sealant (Tisseel). Primary outcome: Flap consolidation, wound healing, and absence of recurrent collection on clinical and CT follow-up.

Q: What does this research mean for the field?

Intercostal artery perforator flap repair provides an effective, muscle-sparing reconstruction for full-thickness anterior thoracic wall defects following transapical transcatheter aortic valve implantation complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

E. Fraccalanza; Alessandra Fin; Nicola Zingaretti; Filippo Contessi Negrini; Enzo Mazzaro; Ugolino Livi; Pier Camillo Parodi

doi:10.1080/23320885.2022.2070490

May 13, 2022Case Reports in Plastic Surgery and Hand SurgeryOpen Access

Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report

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Key Points

To describe the surgical management of a late-presenting subcutaneous thoracic wall collection occurring 18 months after transapical transcatheter aortic valve implantation.
A case report evaluated an 81-year-old male with severe aortic stenosis who developed a chest wall mass 18 months after left anterior mini-thoracotomy for transapical valve implantation.
Diagnostic imaging with thoracic computed tomography and magnetic resonance imaging was followed by surgical drainage, removal of foreign suture material, antibiotic therapy, and debridement.
Soft-tissue reconstruction was performed using a muscle-sparing intercostal artery perforator flap based on a vessel in the 6th intercostal space identified by Doppler ultrasound.
Thoracic computed tomography identified a 40 × 54 × 39 mm plurilocular accumulation extending through the intercostal space between ribs 5 and 6 to the subcutaneous tissues.
The reconstructive procedure was completed in 100 min, successfully filling the full-thickness defect while sparing the internal mammary and thoracodorsal arteries.
Clinical and computed tomography follow-up through June 2019 confirmed complete flap consolidation, stable wound healing, and no recurrence of the collection.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient aged 81 years presenting 18 months after transapical TAVI with a periapical siero-haematic collection and subsequent full-thickness thoracic wall defect, followed for 1 year post-repair.

I

Intervention

Surgical drainage, removal of prior sutures and foreign material, curettage, 2 weeks of postoperative daptomycin therapy, followed 3 weeks later by chest wall reconstruction using a tear-shaped 6th intercostal space intercostal artery perforator (IAP) flap (with distal de-epithelialization and fibrin sealant Tisseel application; 100 min surgical duration) preserving the thoracodorsal and internal mammary arteries.

O

Outcome

Complete consolidation of the flap with thoracic tissues, well-healed scars without thoracic surface distortion, and absence of fluid collection on clinical and CT follow-up at 1 month and 1 year postoperatively.hard clinical

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Implication

An intercostal artery perforator flap offers a rapid, muscle-sparing reconstructive option that preserves the internal mammary and thoracodorsal arteries for managing rare mid-term full-thickness chest wall defects following transapical TAVI.

Abstract

We report the case of a patient who underwent transcatheter aortic valve implantation via left anterior mini-thoracotomy in whom a periapical subcutaneous collection appeared in the anterior thoracic wall 18 months after the procedure. The tissue defect was efficaciously repaired via intercostal artery perforator flap, preserving the thoracodorsal and internal mammary arteries.

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Cite This Study

Fraccalanza et al. (2022) conducted a case report in Periapical subcutaneous siero-haematic collection and full-thickness anterior thoracic wall defect 18 months after transapical transcatheter aortic valve implantation (TA-TAVI) (n=1). Surgical drainage, curettage, daptomycin antibiotic therapy, and chest wall reconstruction using an intercostal artery perforator (IAP) flap with fibrin sealant (Tisseel) was evaluated on Flap consolidation, wound healing, and absence of recurrent collection on clinical and CT follow-up.

synapsesocial.com/papers/6a8965c4851416c68bf7ca28 https://doi.org/10.1080/23320885.2022.2070490

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Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report

Figures

Key Points

Study Design

Structured PICO

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Implication

Abstract

Discussion

Cite This Study

Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report

Figures

Key Points

Study Design

Structured PICO

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Implication

Abstract

Discussion

Cite This Study

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