With the back against the wall: TAVI in a patient with endocarditis.

Transcatheter Aortic Valve Implantation (TAVI) is currently a well-established therapeutic option in patients with severe aortic stenosis considered at prohibitive risk for open heart aortic valve replacement (Cribier et al., Circulation 2002;106:3006-3008; Leon et al., Semin Thorac Cardiovasc Surg 2006;18:165-174). We report a case of a patient with endocarditis by severe homograft aortic stenosis for which a TAVI procedure was performed with an excellent result. The patient was undergoing a presurgery standard screening in preparation for a planned aortic valve replacement operation when he developed a Staphyloccocus aureus sepsis. Transoesophageal echocardiography demonstrated an aortic valve vegetation. A few days later, the patient developed a stroke probably due to embolization of a vegetation. Given the clinical severity of the case a standard open heart aortic valve replacement was considered too risky and the patient underwent a TAVI procedure. Postintervention the patient had a spectacular evolution with fast normalization of the septic shock parameters and clinical status. Antibiotics were continued for a total of nine weeks. By the ambulatory controls at three weeks, two months and six months postdischarge, the patient was completely asymptomatic and his echocardiography showed a normally functioning aortic valve without indications of endocarditis.