Transcatheter Aortic Valve-in-Valve Implantation in a Patient Due to the Degeneratation of the Biointegral Valve Conduit as a Result of Previous Infectious Endocarditis

Graft infection, fistula, and mediastinitis are reported among the serious cardiovascular complications after a Bentall procedure. Surgery associated with antimicrobial treatment is usually recommended but not easily feasible in most cases. In this report, we describe a case of successful valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) in a patient with a degenerated bioconduit from a previously healed infectious endocarditis (IE). The TAVR procedure has been demonstrated to be a therapeutic option in selected cases with a previous history of IE who have been fully treated with antimicrobial therapy and who present a low risk of local re-infection and are deemed at prohibitive or high risk for surgical replacement. Data on TAVR on a bioconduit after a Bentall procedure are scarce. The present case underlines that a long follow-up and individualized treatment could improve the prognosis in patients with a history of prosthetic valve and aortic graft infection and severe valve dysfunction who cannot undergo surgical treatment. The 18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) result could be successfully employed in the decision algorithm. Long-term antibiotic treatment, which could be lifelong in some instances, could be a reasonable choice when the risk of recurrence is associated with the risk for the patient's life.