JACC. Case reports · 2025
Late Complications of TAVR: Endocarditis and Dissection Managed With Strategic Surgery.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Kameda Yuika, Nishida Mayu, Kasai Mio, Yashima Fumiaki, Mori Mitsuharu, Hashizume Kenichi
Аннотация
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.
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.