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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Mitral Valve Repair and SAVR After TAVR Complicated With Endocarditis and Mitral Valve Leaflet Perforation
Razan Salem1, Jan Hlavicka1, Florian Hecker1
1Department of Cardiovascular Surgery, University Hospital and Goethe University Frankfurt, Frankfurt/Main, Germany.
Objectives:
We present our surgical management of a mechanical transcatheter aortic valve replacement (TAVR) complication of an anterior mitral valve leaflet (AML) perforation with infective endocarditis.
Key Steps:
Management consisted of surgical TAVR explantation, transaortic patch plasty of the AML perforation, patch plasty of an aortic laceration by the TAVR valve, and surgical aortic valve replacement.
Potential Pitfalls:
In cases of high operative risk in a technically demanding surgical situation, the surgeon should aim to operate early and avoid extensive surgical trauma and long operation time by addressing the mitral valve through the aorta and choosing repair instead of replacement for AML perforation.
Take-Home Messages:
Poor positioning of TAVR valves can result in severe structural and subsequent infectious complications. Early surgical treatment in high-risk older adult patients can be successfully performed, with favorable outcomes. Scrupulous asepsis and prophylactic perioperative antibiotic therapy are the most important prophylactic measures for prosthetic valve endocarditis.
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