Emergency Transcatheter Aortic Valve Replacement as a Bridge to Surgery for Active Aortic Valve Endocarditis.

BACKGROUND

Infective endocarditis with cardiogenic shock carries high mortality, and many patients are deemed inoperable.

EARLY REPORT SUMMARY: A 73-year-old man with known bicuspid aortic stenosis presented with Gemella haemolysans aortic valve endocarditis with a large vegetation, aortic root pseudoaneurysm, severe left ventricular impairment, and severe aortic regurgitation leading to cardiogenic shock. He was considered unfit for cardiac surgery. Emergency transfemoral transcatheter aortic valve replacement (TAVR) was performed with rapid hemodynamic recovery. Serial computed tomography scans revealed enlarging root pseudoaneurysms prompting surgical root repair and valve replacement 3 weeks post-TAVR. He was discharged home following complete recovery.

DISCUSSION: This case highlights the feasibility of emergency TAVR as a temporising measure in prohibitive-surgical-risk aortic valve endocarditis, despite the presence of large vegetations and root aneurysm.

NOVELTY: To the best of our knowledge, this is the first reported case of emergency TAVR performed as a bridge to surgical aortic valve replacement for active aortic valve endocarditis with multiorgan failure.