Fathi Amir S, Ali Jason M, Mann Sam, Taghavi John, Davies Will R, Sudarshan Catherine
Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK.
Department of Cardiology, Royal Papworth Hospital, Cambridge, UK.
J Card Surg. 2020 Mar;35(3):713-715. doi: 10.1111/jocs.14441. Epub 2020 Jan 30.
The use of transcatheter aortic valve implantation (TAVI) in the emergency setting has not been widely reported, and TAVI is generally contraindicated in the context of endocarditis. Here we describe a patient developing acute cardiogenic shock due to prosthetic aortic valve degeneration with free-flow aortic regurgitation 8 months after receiving treatment for confirmed infective endocarditis. Due to his clinical status, he was deemed unfit for redo surgery, and he underwent salvage valve-in-valve (ViV)-TAVI. The patient made an excellent recovery. Postprocedure he was treated with a 6-week course of antibiotics, and at 18-months follow-up remains very well with no evidence of reinfection. This case may demonstrate that for selected patients with degenerative prosthetic aortic valve disease, despite a history of infective endocarditis, ViV-TAVI may be considered an alternative to redo surgery in the emergency setting.
经导管主动脉瓣植入术（TAVI）在急诊情况下的应用尚未得到广泛报道，并且在感染性心内膜炎的情况下，TAVI通常是禁忌的。在此，我们描述了一名患者，在确诊感染性心内膜炎接受治疗8个月后，因人工主动脉瓣退变伴主动脉瓣反流导致急性心源性休克。由于他的临床状况，被认为不适合再次手术，因此接受了挽救性瓣中瓣（ViV）-TAVI治疗。患者恢复良好。术后他接受了为期6周的抗生素治疗，在18个月的随访中情况良好，没有再次感染的迹象。该病例可能表明，对于某些患有退行性人工主动脉瓣疾病的患者，尽管有感染性心内膜炎病史，在急诊情况下，ViV-TAVI可能被视为再次手术的替代方案。
