Emergent Off-Label TAVR for Native Aortic Valve Endocarditis

A 76-year-old-male transferred to our center with severe breathlessness (New York Heart Association class III-IV). He was afebrile, hypoxic, and tachycardic with a wide pulse-pressure. Chest auscultation revealed a systolic and early diastolic murmur. Two weeks prior to admission, he reported severe cellulitis treated with intravenous antibiotics. Transthoracic echocardiogram demonstrated severe aortic valve (AoV) stenosis and evidence of AoV disruption with mobile vegetations and severe aortic regurgitation (AR) in keeping with plausible infectious endocarditis (IE). Following 3 sets of blood cultures, we treated the patient with intravenous antibiotics and diuretics. Blood cultures were negative, likely due to previous antibiotics treatment. Due to the acute decompensation, he underwent early heart team discussion with a view to urgent surgical AoV replacement. This case example suggests that TAVR with cerebral protection might be a safe treatment option in inoperable patients with AoV IE.