Delayed left anterior mitral leaflet perforation and infective endocarditis after transapical aortic valve implantation-Case report and systematic review.

AIM: We aimed to illustrate the physiopathology of anterior mitral leaflet perforation after TAVI in patients suffering from infective endocarditis (IE).

METHODS AND

RESULTS

The first known case of balloon-expandable transapical case from our series suffering from this complication was reported. In addition, a systematic electronic search of all published cases reporting both entities was performed. Five transfemoral cases have been published to the date, all males with mean age of 79.2 year (range: 66-88). Four were treated with self-expandable prostheses (deeply implanted in the outflow tract). There was moderate residual aortic regurgitation in four. Fever and positive blood cultures for typical micoorganisms were present at certain time point in all cases between the first week and up to 11 months (early IE). Three cases underwent cardiac surgery with adequate outcomes and two others died during hospitalization. Medical management in the case from our series allowed patient's survival at 1-year follow up.

CONCLUSIONS

Early suspicion of IE whenever anterior mitral perforation is found after TAVI can be life-saving. The hypothetical higher risk of this complication due to higher rate of aortic regurgitation has to be prevented through adequate prosthesis depth and careful sterile surgical technique. © 2016 Wiley Periodicals, Inc.