Mitral Valve Repair and SAVR After TAVR Complicated With Endocarditis and Mitral Valve Leaflet Perforation.

OBJECTIVES

We present our surgical management of a mechanical transcatheter aortic valve replacement (TAVR) complication of an anterior mitral valve leaflet (AML) perforation with infective endocarditis.

KEY STEPS

Management consisted of surgical TAVR explantation, transaortic patch plasty of the AML perforation, patch plasty of an aortic laceration by the TAVR valve, and surgical aortic valve replacement.

POTENTIAL PITFALLS

In cases of high operative risk in a technically demanding surgical situation, the surgeon should aim to operate early and avoid extensive surgical trauma and long operation time by addressing the mitral valve through the aorta and choosing repair instead of replacement for AML perforation.

TAKE-HOME MESSAGES: Poor positioning of TAVR valves can result in severe structural and subsequent infectious complications. Early surgical treatment in high-risk older adult patients can be successfully performed, with favorable outcomes. Scrupulous asepsis and prophylactic perioperative antibiotic therapy are the most important prophylactic measures for prosthetic valve endocarditis.