Junaid Khan*, David Daniels, Mitul Kadakia, James Lai and Russell Stanten
Alta Bates Summit Medical Center, USAFulltext PDF
Background: Structural heart valve disease is a growing and changing field with the expansion of indications of Transcatheter Aortic Valve Replacement (TAVR) allowing treatment of more patients across risk stratifications. As TAVR continues to grow and develop, it is important that unique case complications be reported and understood, so physicians can make procedural determinations based on clinical outcomes.
Case Presentation: A 79-year-old female presented to the ER approximately 7 weeks post TAVR with native Basilica procedure. The patient had an acute upper extremity limb threat that was treated by embolectomy. The source of the embolic complication was identified via blood cultures positive for Staph epi and TEE to be a result of prosthetic valve endocarditis. The patient underwent urgent surgical Aortic Valve Replacement where the 26 mm SAPIEN 3 was removed and replaced with a 23 mm INSPIRIS Valve. It was noticed that during the removal of the S3 that there was leaflet vegetation and dehiscence at the LC cusp. On the native valve, heavy calcium was present on the NC and RC cusps, while the LC leaflet was nonexistent. A fistula between NC and RC to LA was repaired. Patient was successfully weaned from CBP and transferred to ICU in critical but stable condition.
Conclusion: During the removal of the S3 TAVR due to endocarditis, the dehiscence of the S3 at the LC and nonexistence of the native LC leaflet where the original basilica was performed draw attention to potential localization of the infection to an area of thermal damage from the electrocautery of the Basilica. It is possible that the active endocarditis infection could have localized to the area of trauma from the leaflet laceration or electrocautery tissue damage resulting in necrosis from the Basilica procedure itself. Continued observation of the localization of infection and tissue necrosis post TAVR with Basilica should be documented.
TAVR; Basilica; INSPIRIS; SAPIEN; Endocarditis; AVR; Dehiscence; Electrocautery; Necrosis; SAVR
Khan J, Daniels D, Kadakia M, Lai J, Stanten R. Absence of Native Left Coronary Leaflet and Localization of Postprocedural Endocarditis Following Transcatheter Aortic Valve Replacement Utilizing Native Basilica Requiring Surgical Intervention. Ann Cardiovasc Surg. 2019; 2(1): 1020.