Key result
Surgical aortic valve replacement was successfully performed to treat prosthetic valve endocarditis 10 months after transcatheter aortic valve implantation.
Why the study?
Patients undergoing TAVI are often frail elderly with comorbidities who face high mortality when invasive intervention is required for complications.
Case Report (n=1)
No
Surgical explantation of an infected self-expanding TAVI valve can be facilitated by cooling the nitinol stent with cold water to maintain its deformed shape below the transformation temperature.
Hypothesis-generating for post-TAVI endocarditis management; leaves open optimal explantation techniques and generalizability.
症例は87歳，男性．2019年1月に重症大動脈弁狭窄症に対して経大腿動脈アプローチにて経カテーテル大動脈弁植込み術（Transcatheter Aortic Valve Implantation ; TAVI）（Evolut PRO 29 mm）を施行した．術後問題なく自宅退院したが術後約8カ月で脳梗塞を契機に入院し血液培養陽性（Viridans Streptococcus），大動脈弁に可動性の疣贅を認め人工弁感染性心内膜炎（Prosthetic Valve Endocarditis ; PVE）と診断した．4週間の抗生剤治療の後，TAVI術後10カ月で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．術後経過は良好で自宅退院となった．TAVI施行患者は併存疾患や脆弱性を有する高齢者であることが多く，合併症が起きた場合における侵襲的治療介入は高い死亡率になる．今回，TAVI術後10カ月で人工弁感染性心内膜炎に対して胸骨正中切開での大動脈弁置換術を施行した際の所見および手術時の工夫について報告する．
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Nomura et al. (2020) conducted a case report in Prosthetic Valve Endocarditis after TAVI (n=1). Surgical aortic valve replacement was evaluated on Clinical outcome after surgical aortic valve replacement. Surgical aortic valve replacement was successfully performed to treat prosthetic valve endocarditis 10 months after transcatheter aortic valve implantation.
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