Acute Transcatheter Aortic Valve Replacement Failure Secondary to Covid-19 Infection

ABSTRACT

Background Valve thrombosis is a documented cause of prosthetic valve failure. Common features include increased cusp thickness, reduced cusp mobility, and increased transvalvular gradient. Case reports have been published of prosthetic valve thrombosis secondary to COVID-19 infection, but this may represent the first documented case of bioprosthetic transcatheter aortic valve replacement (TAVR) thrombosis in the setting of COVID-19. Case A 90 year-old female with atrial fibrillation on apixaban and severe aortic stenosis status-post TAVR with normal valve function on recent echocardiogram presented in clinic with acute chest pain. She was found to have COVID-19 infection and severe bioprosthetic valvular regurgitation with leaflet thickening, abnormal cusp mobility, and elevated transvalvular gradient. [Formula presented] Decision-making Given the time course of valve failure, COVID-19 infection, and echocardiographic features, the patient was diagnosed with bioprosthetic valve thrombosis secondary to COVID-19. She was optimized with diuresis and continued on apixaban before undergoing valve-in-valve TAVR with resolution of valvular dysfunction. Conclusion This case contributes to a body of literature describing thrombotic complications in patients with valve replacement and COVID-19 infection despite concurrent anticoagulation. Increased vigilance and investigations are warranted to better characterize thrombotic risk and optimal antithrombotic strategies in this patient populace.Copyright © 2023 American College of Cardiology Foundation