Implantation of Sutureless Aortic Valve in a High-Risk Patient with Active Infective Endocarditis TAVI

Active infective endocarditis (AIE) is a serious septic risk for all patients, especially if prostheses in conventional aortic valve replacements (AVR) or transcatheter aortic valve implantation (TAVI) are afflicted [1]. Indications for urgent operative debridement and valve replacement in complicated cases of AIE that cannot always be managed with conventional appropriate antibiotic therapy such as embolisms, multi resistantor atypical pathogens, including methicillin resistant staphylococcus aureus (MRSA) and fungi, recurring IE and acute heart failure [2,3]. However, this is in conflict with a fraction of the patient population at high or very high operative risk according to Euro SCORE II [4]. In fact, with increasing age and multi-morbidity, operative risk profiles are increasing over time [5]. A strategy to circumvent this dilemma has been the introduction of TAVI systems for high-risk or inoperable patients [6,7]. However, also TAVI valves are at risk of AIE, leaving patients at a dead end concerning operative endocarditis treatment, as complicated courses of AIE need surgical decontamination and debridement before implanting a new valve [8-10]. Sutureless heart valves can decrease the operative risk by reduction of cross-clamp-, cardio pulmonary bypass, and thus overall operative time [11]. This is not only beneficial regarding peri-operativeand short-term mortality, but also reduces the risk for additional inflammation in these already septic patients [12,13]. We report the successfully use of a sutureless aortic in a patient with AIE-TAVI.