MANAGEMENT
Patient was admitted to the Internal medicine floor and Infectious diseases team were consulted, they concurred with the current treatment plan of Cefazolin and Vancomycin. After the TEE findings and normal cardiac catheterization, we decided to move forward with surgery. Due to the patient’s co-morbid status, Euro score of 15% and high mortality risk, it was deemed that the surgery should take place in a hybrid operating room setting. The patient underwent surgery - a redo-sternotomy in the standard fashion- and a large abscess cavity was seen surrounding the aortic graft. Following the abscess drainage, the cavity was washed with antibiotic solution with placement of antibiotic beads around the graft, and the sternum was closed. The bacterial culture of pus and tissue collected during the surgery was negative.
The heart team performed a Trans Catheter Aortic Valve Implantation (TAVI) valve in valve procedure (Figure 1B) and (Video 1) . A 14 French pro-glide sheath and a 6 French pro-glide sheath were used in the right and left femoral arteries respectively. A Medtronic CoreValue Evolut R 26 mm valve (CoreValve, Medtronic, Luxembourg) was used. Post-operative ECHO showed a well-seated aortic valve with a mean gradient of 8 mmHg and no leaks noted (Figure 2C) and(Video 2) .
Postoperatively, the patient’s recovery was complicated with right heart failure (RHF) and symptomatic bradycardia that resolved. It was decided that the patient will remain on lifelong suppressive antibiotic therapy with daily Cefadroxil 1gm orally.