Transcatheter aortic valve-in-valve implantation for residual prosthetic valve dysfunction and paravalvular leak after healed Enterococcus faecalis prosthetic valve endocarditis: a case report.

Background: Prosthetic valve endocarditis (PVE) is associated with substantial morbidity and mortality, particularly when complicated by severe prosthetic valve dysfunction and paravalvular leak. Although redo surgery remains the standard treatment, some patients may be unsuitable for surgical intervention because of prohibitive operative risk. Case summary: A 64-year-old man with previous surgical bioprosthetic aortic valve replacement had a history of Enterococcus faecalis PVE and received targeted antimicrobial therapy. Following targeted antimicrobial therapy with documented microbiological control, he presented with cardiogenic shock due to severe residual prosthetic valve dysfunction, including severe prosthetic stenosis, severe central transprosthetic regurgitation, and severe paravalvular leak. Given his prohibitive surgical risk, the multidisciplinary Heart Team selected transfemoral valve-in-valve transcatheter aortic valve implantation as a rescue strategy. The procedure resulted in marked haemodynamic improvement with only mild residual regurgitation. At 1-year follow-up, the patient remained clinically stable with a well-functioning prosthetic valve and no evidence of recurrent infection. Discussion: This case demonstrates that valve-in-valve transcatheter implantation may be considered as a rescue option in carefully selected patients with controlled prosthetic valve endocarditis and residual prosthetic valve dysfunction who are unsuitable for redo surgery. Multimodality imaging and multidisciplinary Heart Team evaluation are essential for individualized decision-making in this challenging clinical scenario.