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Updated: Jan 12, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Late Complications of TAVR: Endocarditis and Dissection Managed With Strategic Surgery
Yuika Kameda1, Mayu Nishida1, Mio Kasai1
1Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
Background:
Prosthetic valve endocarditis (PVE) and aortic dissection are rare but severe complications of transcatheter aortic valve replacement (TAVR), with no standardized surgical approach.
Case Summary:
A 74-year-old woman developed PVE 6 months after TAVR with an Evolut PRO+ valve (Medtronic). Echocardiography revealed valve vegetation and perivalvular leakage, and computed tomography showed localized ascending aortic dissection. Emergency surgery involved careful removal of the Evolut PRO+ using sutureless aortic valve replacement and ascending aorta replacement.
Discussion:
Successful management of TAVR-related PVE with aortic dissection in high-risk patients requires a clear understanding of prosthetic valve characteristics and tailored surgical planning. Techniques such as cold-water explantation and sutureless aortic valve replacement can be particularly useful in minimizing operative risk.
Take-Home Messages:
This case highlights a reproducible strategy for complex TAVR complications. Cold-water explantation and the snare technique allows safe valve removal, while sutureless aortic valve replacement shortens procedural time, offering practical advantages in high-risk patients.
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