Arizona Heart Hospital

Myroides species, previously known as Flavobacterium, are rare, opportunistic Gram-negative bacilli primarily found in environmental sources such as water and soil and are infrequently implicated in human infection. When present, infection is often associated with multidrug- resistance and immunocompromised hosts. Cutaneous wound infections caused by Myroides spp. remain poorly described in the literature. We report a case of Myroides odoratus/odoratimimus isolated from chronic bilateral venous stasis ulcers in a 78-year-old man with significant cardiovascular disease and chronic venous insufficiency who presented with acute bilateral lower-extremity cellulitis and sepsis. The patient exhibited hypotension, tachycardia, acute kidney injury, and malodorous wound drainage, prompting initiation of broad-spectrum intravenous antimicrobial therapy. Wound cultures subsequently identified Myroides spp. with concern for multidrug-resistance, and the patient demonstrated clinical improvement with continued culture-directed management. This case emphasizes the ability of Myroides spp. to cause acute severe infection in chronic venous ulcers, highlighting the importance of early recognition and microbiologic diagnosis in guiding appropriate therapy.

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Short-frame balloon-expandable valves implanted within failed short- or tall-frame transcatheter valves ("short-in-short" and "short-in-tall") pose specific challenges, including coronary risk assessment, valve sizing, anchoring, and preservation of coronary access. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel of experts reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic workflow for redo-TAVR. This document standardizes key anatomic definitions, outlines computed tomography-based strategies for in vivo sizing, and details recommended approaches to predilatation, deployment techniques, and postdilatation. By harmonizing terminology and stepwise planning across imaging, interventional, and surgical teams, this document aims to simplify procedural decision-making and improve safety, coronary preservation, and hemodynamic outcomes in patients undergoing short-in-short and short-in-tall TAV-in-TAV procedures.

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Tall-frame self-expanding valves implanted within failed short- or tall-frame transcatheter valves ("tall-in-short" and "tall-in-tall") present distinct challenges related to anchoring, constrained expansion, valve alignment, and the risk for coronary obstruction or sinus sequestration driven by the resulting neoskirt plane. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic procedural workflow for redo-TAVR in these settings. This consensus document standardizes key definitions, outlines computed tomography-based strategies for in vivo sizing and risk stratification, and details recommended approaches to predilatation, deployment technique, postdilatation, coronary protection and leaflet modification, or hybrid surgical alternative when needed. A structured troubleshooting guide is provided to support safe, reproducible execution and coronary preservation.