RESUMO
We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.
Assuntos
Insuficiência da Valva Aórtica/etiologia , Valva Aórtica/patologia , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/microbiologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Corynebacterium/isolamento & purificação , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Endocardite/patologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/patologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Resultado do TratamentoRESUMO
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.