Massive Thrombosis of Mitral Bioprosthesis Due to SARS-CoV-2 Infection.

Thromboembolic events have been reported as frequent and fearsome complications in patients affected by SARS-CoV-2 infection. Patients undergoing cardiac valve replacement exhibit an increased risk of valve thrombosis, even with prosthetic biological valves, and especially in the first period after surgery. The management of these patients is challenging and requires prompt interventions. We report the case of a young woman infected by SARS-CoV-2 three months after double cardiac valve replacement that developed a massive prosthetic biological valve thrombosis despite optimal anticoagulant therapy.

Abstract Journal Cardiothoracic Surgery

CS020P TRANSCATHETER MITRAL VALVE-IN-VALVE REPLACEMENT IN A YOUNG ABORIGINAL PATIENT WITH SEVERE SOC... Abbey Knox, Damian Gimpel, Ajay Sinhal and Jayme Bennetts Flinders Medical Centre, SA B Purpose: b Transcatheter mitral valve-in-valve (TMVIV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprosthesis. Demographic data, number of grafts, type of surgery (e.g., isolated CABG, CABG and valvular surgery), comorbidities, in-hospital stay post-surgery, and complications within 6 weeks of surgery were tabulated. To inform clinical decision-making for high-risk surgical patients, we performed a systematic review and meta-analysis aiming to characterise the outcomes of COVID-19 positive patients undergoing cardiac surgery. CARDIAC SURGERY FOR PATIENTS WITH COVID-19 - A SYSTEMATIC REVIEW AND META-ANALYSIS Aashray Gupta, Alasdair Leslie, Joseph Hewitt, Joshua Kovoor, Christopher Ovenden, Suzanne E... University of Adelaide, SA B Purpose: b The COVID-19 pandemic has had significant impact on global surgery. [Extracted from the article] Copyright of ANZ Journal of Surgery is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

DELAYED DIAGNOSIS OF HISTOPLASMOSIS IN A PATIENT WITH A PROSTHETIC AORTIC VALVE

Background: Histoplasmosis is a rare cause of infective endocarditis. Here we describe a case of disseminated histoplasmosis involving a prosthetic aortic valve (AV). Case: A 50-year-old male from Ohio, with history notable for congenital aortic valve disease status post bioprosthetic AV replacement (AVR) in 2014, presented with 6 months of flu-like illness, pancytopenia, and suspected transient ischemic attack after receiving the COVID-19 Johnson & Johnson vaccine, posing concern for post-vaccination reaction. However, COVID-19 polymerase chain reaction testing was negative. Detailed workup revealed myelodysplastic syndrome and positive urine histoplasmosis antigen. Chest computed tomographic angiography (CTA) demonstrated a 16x16 mm left lower lobe pulmonary nodule with central cavitation suspicious for pulmonary histoplasmosis. Transesophageal echocardiography (TEE) showed bulky thickening of the prosthetic leaflets with suspected vegetation causing severe prosthetic aortic stenosis. Head and neck CTA showed no mycotic aneurysms. Decision-making: He was treated with Amphotericin B and underwent redo AVR. Intraoperative findings included a very large vegetation with near-total obstruction of the aortic valve and circumferential necrotic tissue of the aortic root (Figure 1). Conclusion: Despite its rare incidence, histoplasmosis should remain on the differential for infective endocarditis in patients presenting with systemic illness and prosthetic valves. [Formula presented]

Professionals' views on shared decision-making in severe aortic stenosis.

OBJECTIVE: To provide insight into professionals' perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS). METHODS: A semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data. RESULTS: Four primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients' wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS. CONCLUSIONS: Professionals struggle to make highly complex treatment decisions part of SDM and to embed patients' expectations of treatment and patients' preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.

'Valve for Life': tackling the deficit in transcatheter treatment of heart valve disease in the UK.

Transcatheter aortic valve implantation (TAVI) is a proven treatment for life-threatening aortic valve disease, predominantly severe aortic stenosis. However, even among developed nations, access to TAVI is not uniform. The Valve for Life initiative was launched by the European Association of Percutaneous Cardiovascular Interventions in 2015 with the objective of improving access to transcatheter valve interventions across Europe. The UK has been identified as a country with low penetration of these procedures and has been selected as the fourth nation to be included in the initiative. Specifically, the number of TAVI procedures carried out in the UK is significantly lower than almost all other European nations. Furthermore, there is substantial geographical inequity in access to TAVI within the UK. As a consequence of this underprovision, waiting times for TAVI are long, and mortality among those waiting intervention is significant. This article reviews these issues, reports new data on access to TAVI in the UK and presents the proposals of the UK Valve for Life team to address the current problems in association with the British Cardiovascular Intervention Society.