[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-detail-445538-en":59,"doc-seo-445538-105":80},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":5,"data":60},{"doc_id":61,"user_id":62,"nickname":63,"user_avatar":64,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":66,"doc_content":67,"file_id":68,"file_url":69,"file_type":70,"file_size":71,"view_count":72,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":73,"language_code":74,"site_id":75,"html_lang":74,"table_of_contents":76,"faqs":77,"seo_title":78,"seo_description":66,"update_tm":79,"read_time":24},445538,16904993612988,"Olivia Brown","https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Comment to the article - Complicated transcatheter aortic valve implantation endocarditis and possible challenges - Letter to the Editor","Letter to the Editor discussing the clinical significance of complicated transcatheter aortic valve implantation (TAVI) endocarditis. The authors emphasize that acute-subacute prosthetic valve endocarditis is difficult to treat and describe a case suggesting endocarditis supported by imaging findings and positive blood cultures, with possible asymptomatic annular rupture. They further propose that vasoplegic syndrome (VS) may have developed after cardiopulmonary bypass, outlining its definition and relating VS risk to surgical and patient factors, including high surgical risk, comorbidities, medication history, and procedural duration.","Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):582-583  \nLetter to the Edıtor / Editöre Mektup  \nComment to the article: Complicated transcatheter aortic valve implantation  \nendocarditis and possible challenges  \nMakaleye yorum: Komplike transkateter aort kapak implantasyon endokarditi ve olası zorluklar  \nİhsan Alur1􀀬, Ahmet Deniz Kaya2􀀬  \nInstitution where the research was done:  \nPrivate Doruk Hospital, Bursa, Türkiye  \nAuthor Affiliations:  \n1Department of Cardiovascular Surgery, Private Doruk Hospital, Bursa, Türkiye  \n2Department of Cardiovascular Surgery, Ministry of Health Bursa High Training and Research Hospital, Bursa, Türkiye  \nWith great interest, we read the article by Bozkurt et al. [1] titled “Surgical Approach to Complicated Transcatheter Aortic Valve Implantation Endocarditis,” published in Turkish Journal of Thoracic and Cardiovascular Surgery. We would like to highlight the importance of this issue in cardiovascular surgery.  \nTranscatheter aortic valve implantation (TAVI), which has become widely used as an alternative to surgical treatment in recent years, may have serious complications . Acute-subacute prosthetic valve endocarditis is one of these complications, and its treatment is quite challenging. [2] In this case, aortic root pseudoaneurysm on computed tomography, aortic root abscess on transesophageal echocardiogram, and positive blood cultures indicate endocarditis . Furthermore, a small, asymptomatic TAVI annular rupture appears to have occurred in this case. The patient's surgical treatment was successful, for which we congratulate the authors . The absence of postoperative bleeding, blood product transfusion, and the patient's ability to be weaned from cardiopulmonary bypass (CPB) indicate that the operation was performed successfully. It is not difficult to predict that the treatment of such cases of prosthetic valve endocarditis is challenging and the mortality rate is high. It is possible that this patient  \nmay have developed vasoplegic syndrome (VS), a clinical entity.  \nThis is thought to be an immunoinflammatory and neurohumoral response of the body to prolonged trauma or tissue damage. [3] Vasoplegic syndrome is a condition that can occur after cardiac surgery and is often fatal. This condition is characterized by low systemic vascular resistance, insensitivity to vasopressor drugs, resistant hypotension and hyperlactatemia despite normal or increased cardiac output.[3] In this case, despite remaining normotensive with inotropic support until the seventh postoperative hour, the patient's need for high-dose vasoconstrictors after the seventh hour, acute renal failure, acidosis, insensitivity to inotropic drugs, and circulatory collapse suggest VS. Vasoplegic syndrome after CPB has been reported to develop in 5 to 20% of cases and is associated with the preoperative clinical condition (high surgical risk score), history of angiotensinconverting enzyme (ACE) inhibitor use, chronic renal failure, anemia, redo cardiac surgery, prolonged cross-clamping and CPB duration, and massive blood transfusion . [4] It can be speculated that, in this case, the high surgical risk score due to advanced age (81 years old), female sex, and redo surgery, as well as prolonged cross-clamping and CPB duration, may have facilitated the development of VS.  \nCorresponding author: İhsan Alur.  \nE-mail: [alur_i@hotmail.com](alur_i@hotmail.com)  \nDoi: 10.5606/tgkdc.dergisi.2025.28412  \nReceived: August 06, 2025  \nAccepted: September 24, 2025  \nPublished online: October 20, 2025  \nCite this article as: Alur İ, Kaya AD. Comment to the article: Complicated transcatheter aortic valve implantation endocarditis and possible challenges . Turk Gogus Kalp Dama 2025;33(4):582-583 . doi: 10.5606/tgkdc. dergisi.2025.28412 .  \n©2025 All right reserved by the Turkish Society of Cardiovascular Surgery.  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, whi","cbCail71RdoNyChC","https://ap.wps.com/l/cbCail71RdoNyChC","pdf",194178,3,"English","en",105,"# Letter to the Editor\n## Clinical context and endocarditis challenges\n## Vasoplegic syndrome definition and proposed cause\n## Surgical risk factors and conclusion","[{\"question\":\"What complication is highlighted in relation to TAVI?\",\"answer\":\"Acute-subacute prosthetic valve endocarditis is highlighted as a serious complication that is particularly challenging to treat.\"},{\"question\":\"What clinical scenario suggests vasoplegic syndrome after surgery?\",\"answer\":\"The letter links vasoplegic syndrome to postoperative findings such as need for high-dose vasoconstrictors, acute renal failure, acidosis, insensitivity to inotropic drugs, and circulatory collapse despite earlier normotension.\"},{\"question\":\"Which factors may increase the risk of vasoplegic syndrome in this context?\",\"answer\":\"The authors suggest that advanced age, female sex, redo surgery, prolonged cross-clamping and cardiopulmonary bypass duration, and other preoperative conditions may have facilitated development of VS.\"}]","Comment to the article - Complicated transcatheter aortic valve implantation endocarditis and possible challenges - Letter to the Editor | PDF",1790712361,{"code":4,"msg":81,"data":82},"ok",{"site_id":75,"language":74,"slug":83,"title":65,"keywords":84,"description":66,"schema_data":85,"social_meta":138,"head_meta":140,"extra_data":142,"updated_unix":143},"comment-to-the-article-complicated-transcatheter-aortic-valve-implantation-endocarditis-and-possible-challenges-letter-to-the-editor","",{"@graph":86,"@context":137},[87,100,120],{"@type":88,"itemListElement":89},"BreadcrumbList",[90,94,96,98],{"item":91,"name":92,"@type":93,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":95,"name":9,"@type":93,"position":14},"https://docshare.wps.com/document/",{"item":97,"name":35,"@type":93,"position":72},"https://docshare.wps.com/document/healthcare/",{"item":99,"name":65,"@type":93,"position":19},"https://docshare.wps.com/document/comment-to-the-article-complicated-transcatheter-aortic-valve-implantation-endocarditis-and-possible-challenges-letter-to-the-editor/445538/",{"url":99,"name":65,"@type":101,"image":102,"author":107,"headline":65,"publisher":109,"fileFormat":112,"inLanguage":74,"description":66,"dateModified":113,"datePublished":114,"encodingFormat":112,"isAccessibleForFree":115,"interactionStatistic":116},"DigitalDocument",{"url":103,"@type":104,"width":105,"height":106},"https://docshare.wps.com/thumbnails/comment-to-the-article-complicated-transcatheter-aortic-valve-implantation-endocarditis-and-possible-challenges-letter-to-the-editor/445538.png","ImageObject",300,407,{"name":63,"@type":108},"Person",{"url":91,"name":110,"@type":111},"DocShare","Organization","application/pdf","2026-10-03","2026-09-29",true,{"@type":117,"interactionType":118,"userInteractionCount":72},"InteractionCounter",{"@type":119},"ViewAction",{"@type":121,"mainEntity":122},"FAQPage",[123,129,133],{"name":124,"@type":125,"acceptedAnswer":126},"What complication is highlighted in relation to TAVI?","Question",{"text":127,"@type":128},"Acute-subacute prosthetic valve endocarditis is highlighted as a serious complication that is particularly challenging to treat.","Answer",{"name":130,"@type":125,"acceptedAnswer":131},"What clinical scenario suggests vasoplegic syndrome after surgery?",{"text":132,"@type":128},"The letter links vasoplegic syndrome to postoperative findings such as need for high-dose vasoconstrictors, acute renal failure, acidosis, insensitivity to inotropic drugs, and circulatory collapse despite earlier normotension.",{"name":134,"@type":125,"acceptedAnswer":135},"Which factors may increase the risk of vasoplegic syndrome in this context?",{"text":136,"@type":128},"The authors suggest that advanced age, female sex, redo surgery, prolonged cross-clamping and cardiopulmonary bypass duration, and other preoperative conditions may have facilitated development of VS.","https://schema.org",{"og:url":99,"og:type":139,"og:title":65,"og:site_name":110,"og:description":66},"article",{"robots":141,"canonical":99},"index,follow",{"doc_id":61,"site_id":75},1790765827]