Case report: Salvage transcatheter aortic valve replacement for acute aortic regurgitation due to prosthetic valve endocarditis

Aortic prosthetic valve endocarditis can cause complex clinical pictures in the setting of cardio embolisms, acute severe aortic regurgitation, and refractory cardiogenic shock requiring emergent intervention. We present a case of a 63-year-old patient with a prior Bentall procedure and bioprosthetic aortic valve replacement presented with Streptococcus sanguinis prosthetic valve endocarditis complicated by multiple septic emboli, acute severe aortic regurgitation, ventricular tachycardia, and cardiogenic shock requiring mechanical ventilation and vasopressors. The heart team deems immediate redo surgery prohibitively high risk because of acute embolic strokes with concern for hemorrhagic conversion, severe obesity, heavily calcified homograft material, and a complex surgical history. Valve-in-valve transcatheter aortic valve replacement with cerebral embolic protection was performed as a temporizing rescue therapy, leading to immediate hemodynamic improvement and successful weaning from vasoactive support. This case highlights the role of salvage transcatheter aortic valve replacement as a bridge to definitive surgical management in selected high-risk patients.