Aortic Root and Tricuspid Annulus Reconstruction for Transcatheter Valve Replacement–Associated Infective Endocarditis in an Octogenarian

BACKGROUND: Prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR) is a rare and life-threatening complication, particularly in elderly patients. CASE SUMMARY: An 88-year-old man with a previous TAVR was readmitted 2 months after the procedure with fever (38.6 °C). Blood cultures were positive for methicillin-resistant Staphylococcus epidermidis. We performed extensive surgical debridement and reconstruction of the aortic root and tricuspid annulus, followed by a Bentall procedure and tricuspid valve replacement. The postoperative course was favorable, with good early recovery and normally functioning prostheses at follow-up. DISCUSSION: This case illustrates that, even in octogenarian patients with prohibitive surgical risk and extensive multivalvular involvement, aggressive surgical management guided by a multidisciplinary heart team may provide favorable outcomes when medical therapy alone fails to control infection. TAKE-HOME MESSAGES: TAVR-associated prosthetic valve endocarditis may present with extensive perivalvular and multivalvular involvement. Surgical treatment, although rarely performed in this setting, can be lifesaving when guided by careful patient selection and multidisciplinary evaluation.