Severe Perivalvular Abscess After ViV-TAVR for Infective Endocarditis Following SAVR Accompanied Multiple Comorbidities

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is contraindicated in active infective endocarditis (IE). However, valve-in-valve TAVR (ViV-TAVR) may be an alternative in high-surgical-risk patients with prosthetic valve dysfunction, even with prior IE. CASE SUMMARY: A patient developed structural valve deterioration of the bioprosthetic aortic valve 1 year after initial surgery, requiring reintervention. Comorbidities included lung cancer with bone metastasis and a history of IE. With an STS PROM of 10.2%, the patient was considered too high risk for redo sternotomy, and ViV-TAVR was pursued after 1 year of antimicrobial therapy. Postoperatively, a perivalvular abscess was found at 1 month, and the patient died 3 months later due to massive gastrointestinal bleeding. DISCUSSION: This case illustrates the use of ViV-TAVR in a high-risk patient with prior IE. It highlights the need for intensified postoperative antibiotic therapy, even without clear signs of active infection. TAKE-HOME MESSAGES: ViV-TAVR may be an option in high-risk patients with healed IE, provided infection resolution is clearly established. Postoperative anti-infective therapy should be optimized individually based on comorbidities and infection history. Diabetes may be a risk factor for poorer outcomes in such cases.