Key result
Prolonged antibiotic therapy enables successful third TAVR implantation for endocarditis with structural degeneration.
Why the study?
Infective endocarditis after TAVR is rare but serious, often requiring surgery, with limited data on medical management and redo TAVR in high-risk patients.
Does prolonged medical management followed by TAVR-in-TAVR-in-TAVR improve outcomes in frail patients with post-TAVR endocarditis and structural valve degeneration?
Case Report (n=1)
Does prolonged medical management followed by TAVR-in-TAVR-in-TAVR improve outcomes in frail patients with post-TAVR endocarditis and structural valve degeneration?
Lifelong antibiotics and redo TAVR may be a viable alternative to surgery for frail patients with post-TAVR endocarditis and subsequent structural valve degeneration.
May offer a nonsurgical option for frail elderly with post-TAVR endocarditis and SVD; leaves open its role versus surgery.
BACKGROUND: Infective endocarditis after transcatheter aortic valve replacement (TAVR) is a rare but serious condition, with high morbidity and mortality, often requiring surgery. CASE SUMMARY: An 89-year-old woman with prior TAVRs (Sapien 3 and Evolut Pro) presented with dyspnea and fever. Blood cultures grew Staphylococcus hominis, and imaging confirmed endocarditis with minimal aortic regurgitation. She was deemed inoperable owing to age and comorbidities and was treated with lifelong antibiotics. After 18 months, she developed severe aortic regurgitation and heart failure due to structural valve degeneration (SVD). Active infection was excluded, and TAVR-in-TAVR-in-TAVR using a 20-mm Sapien 3 Ultra was performed successfully. DISCUSSION: This case illustrates the feasibility of prolonged medical management for post-TAVR endocarditis in high-risk patients, with redo TAVR for subsequent SVD. TAKE-HOME MESSAGE: Lifelong antibiotics and redo TAVRs in case of later SVD may be viable in frail patients, avoiding the risks of surgery.
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Brito et al. (2025) conducted a case report in Post-TAVR infective endocarditis and structural valve degeneration (n=1). Medical management and TAVR-in-TAVR-in-TAVR was evaluated. Prolonged medical management followed by TAVR-in-TAVR-in-TAVR was successfully performed in an 89-year-old woman with post-TAVR endocarditis and structural valve degeneration.
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