Cusp Tear of Trifecta™ Aortic Bioprosthesis Resulting in Acute Heart Failure

Herein is presented the case of an 83-year-old male patient in cardiogenic shock with acute aortic regurgitation that occurred six years after aortic valve replacement (AVR) with a 23 mm Trifecta™ valve. Prosthesis endocarditis was initially suspected because of a floating structure attached to the aortic valve that was visible on echocardiography. Emergency redo-AVR surgery was performed, but no signs of endocarditis were found intraoperatively. Hence, cusp tearing of the implanted bioprosthesis was considered to be the reason for the severe aortic regurgitation.