Key result
Surgical aortic valve replacement was successfully performed without recurrence of infection in an 81-year-old woman who developed prosthetic valve endocarditis 6 months after TAVI.
Why the study?
Although TAVI patients are typically elderly with comorbidities and high surgical risk, radical open-heart surgery must be considered when medical therapy fails for post-TAVI prosthetic valve endocarditis.
Case Report (n=1)
No
Radical surgical treatment (SAVR) can be a viable and effective option for patients with prosthetic valve endocarditis after TAVI when medical therapy fails, despite their generally high surgical risk.
Surgical explantation may be feasible for refractory post-TAVI PVE; this case leaves open optimal patient selection and timing.
症例は81歳女性．約半年前に当院で重症大動脈弁狭窄症に対してTAVI（Evolut PRO® 26 mm）を施行した．術後合併症なく軽快退院となったが，術後6カ月で発熱，腰痛，炎症所見高値を認めた．腰椎MRIで，化膿性脊椎炎，硬膜外膿瘍の診断となり，ドレナージ手術が行われた．その際の血液培養は陽性（Enterococcus faecalis）であった．頭部のMRIで右前頭葉に点在する亜急性の梗塞像が認められ，経食道心エコー検査では人工弁尖に高輝度の付着物を認め疣贅が疑われた．人工弁感染性心内膜炎（PVE）の診断となり保存的に抗菌薬加療を開始したが，徐々に疣贅の増大や可動性を認めたため，外科手術の方針とした．胸骨正中切開にて人工弁摘出術，大動脈弁置換術を施行した．術後経過は良好で，感染の再燃なく術後26日目に他病院へリハビリ目的に転院となった．一般的にTAVI患者は高齢で併存疾患も多く，手術リスクが高いが，TAVI後のPVEにおいて，内科的治療が奏功しない場合には開胸による根治手術を考慮する必要がある．今回TAVI後のPVEに対して外科的大動脈弁置換術を施行した症例を経験したため報告する．
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Tokushima et al. (2024) conducted a case report in Prosthetic valve endocarditis after TAVI (n=1). Surgical aortic valve replacement was evaluated on Postoperative recovery and infection recurrence. Surgical aortic valve replacement was successfully performed without recurrence of infection in an 81-year-old woman who developed prosthetic valve endocarditis 6 months after TAVI.
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