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Emergent Off-Label TAVR for Native Aortic Valve Endocarditis
Andreas S Kalogeropoulos1, Simon R Redwood, John Klein
1Andreas Kalogeropoulos, MD, PhD, FRCP, FESC, Department of Cardiology, Mitera General Hospital Hygeia Healthcare Group, Athens, Greece. andkalog@gmail.com.
The Journal of Invasive Cardiology
|November 1, 2022
Summary
This case highlights a severe aortic valve stenosis and infectious endocarditis. Transcatheter aortic valve replacement (TAVR) with cerebral protection may be a safe option for inoperable patients.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- A 76-year-old male presented with severe breathlessness, hypoxia, and tachycardia.
- Physical examination revealed a systolic and early diastolic murmur, suggestive of aortic valve disease.
- The patient had a history of severe cellulitis treated with antibiotics prior to admission.
Purpose of the Study:
- To describe a case of severe aortic valve stenosis and infectious endocarditis.
- To evaluate the potential of transcatheter aortic valve replacement (TAVR) with cerebral protection in an inoperable patient.
Main Methods:
- Transthoracic echocardiogram revealed severe aortic valve stenosis, disruption, mobile vegetations, and severe aortic regurgitation.
- Blood cultures were obtained, and the patient was treated with intravenous antibiotics and diuretics.
- An early heart team discussion was held for urgent surgical aortic valve replacement due to acute decompensation.
Main Results:
- Blood cultures were negative, likely due to prior antibiotic treatment.
- The patient experienced acute decompensation, necessitating urgent intervention.
- The case suggests TAVR with cerebral protection as a potential safe treatment for inoperable patients with aortic valve endocarditis.
Conclusions:
- Infectious endocarditis can lead to severe aortic valve dysfunction and acute decompensation.
- Transcatheter aortic valve replacement (TAVR) with cerebral protection may be a viable and safe option for inoperable patients with aortic valve endocarditis.
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