Pseudomonas aeruginosa Infective Endocarditis Following Transcatheter Aortic Valve Implantation: A Note of Caution



Juan Ignacio Dapás1, Cynthia Rivero1, Pablo Burgos2, Andrea Vila1, *
1 Department of Infectious Diseases, Hospital Italiano de Mendoza, Argentina
2 Department of Cardiovascular Surgery, Hospital Italiano de Mendoza, Argentina


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© Dapás et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Infectious Diseases, Hospital Italiano de Mendoza, Avenida Acceso Este 1070, Guaymallén, Mendoza, Argentina; Tel: 54 261 4608735 Email: santander@arlink.net.ar


Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe aortic valve stenosis (AS) in patients with prohibitive risk for surgical aortic valve replacement (SAVR). Prosthetic valve endocarditis (PVE) is a rare complication of this relatively novel procedure and current guidelines do not include specific recommendations for its treatment.

We report a case of PVE due to Pseudomonas aeruginosa after TAVI that required SAVR, with successful outcome.

PVE usually occurs during the first year after TAVI and entails a high mortality risk because patients eligible for this min-imally invasive procedure are fragile (i.e. advanced age and/or severe comorbidities). Additionally, clinical presentation may be atypical or subtle and transesophageal echocardiogram (TEE) may not be conclusive, which delays diagnosis and treatment worsening the prognosis. This case highlights that open SAVR might be ultimately indicated as part of treatment for TAVI-PVE despite a high-risk surgery score.

Keywords: Infective endocarditis, prosthetic valve endocarditis, Pseudomonas aeruginosa, TAVI, TAVI associated endocarditis, transcatheter aortic valve implantation.