A 54-year-old patient is admitted for thermometric fever of 38°C in the previous five days and dyspnea at rest (LV) that appeared 6 hours before coming to the hospital. Examination in the emergency room was compatible with heart failure and the ECG showed complete atrioventricular block with an escape ventricular rate of 45 bpm. Signs of heart failure are refractory to medical treatment and transesophageal echocardiography shows an aortic valve with an effective regurgitant orifice of 0.5 cm2_ Serial cultures are positive for Streptococcus gallolyticus. Indicate the best course of action:
Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.
Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.
Antibiotic therapy according to antibiogram and implantation of intra-aortic balloon counterpulsation and transient pacemaker for up to 3 weeks, after which a permanent pacemaker will be implanted.
Implantation of transient pacemaker, antibiotic therapy according to antibiogram and percutaneous implantation of aortic valve prosthesis.
Urgent implantation of definitive pacemaker with antibiotic therapy according to antibiogram for 6 weeks.
Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.