Simple surgical explant technique for the EDWARDS INTUITY rapid deployment valve: a case report of prosthetic valve endocarditis

TL;DR

A simple surgical technique was used to successfully remove a problematic rapid deployment heart valve in a patient with an infection.

Contribution

A safe and feasible explantation method for rapid deployment valves in prosthetic valve endocarditis is described.

Findings

The technique involved separating the valve's rigid and transformable parts to remove the textured sealing cuff safely.

No annular or sub-annular damage was observed during the procedure.

The patient recovered well after surgery and antimicrobial therapy.

Abstract

A rapid deployment valve can shorten operation times and improve hemodynamics. However, explantation can be challenging because of the unique structure of such valves, including an inflow frame covered by textured sealing cloth beneath the sewing cuff. In this case, we report a simple explantation technique.

This case involved a 79-year-old woman with prosthetic valve endocarditis who had undergone aortic valve replacement with a rapid deployment valve 5 years earlier. Preoperative echocardiography revealed severe mitral regurgitation and a highly mobile mass on the posterior leaflet. The prosthetic valve had thickened cusps without regurgitation. Emergent surgery was performed to explant the prosthetic valve and replace both the aortic and mitral valves through a re-median sternotomy under routine cardiopulmonary bypass support. The textured sealing cuff was detached from the surrounding tissue after separating the rigid outflow portion from the transformable inflow portion by cutting the fabric. No annular or sub-annular damage was observed. Enterococcus faecalis was cultured from the blood. The patient received 6 weeks of antimicrobial therapy and was discharged without symptoms of heart failure or infection.

The patient successfully underwent valve explantation and double valve replacement for prosthetic valve endocarditis. This method is safe and feasible for explanting rapid deployment valves with minimal tissue damage.

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