Right-Sided Infective Endocarditis After Edge-to-Edge Transcatheter Tricuspid Valve Repair

Tricuspid transcatheter edge-to-edge repair (T-TEER) is an emerging treatment option in symptomatic patients with severe tricuspid regurgitation (TR) and high surgical risk. TEER devices can become infected.

An 87-year-old female with previous admissions for heart failure was diagnosed with massive atrial-secondary TR. The case was discussed in the Heart-Team meeting. Based on her surgical risk (Society of Thoracic Surgeons score: 15.3%), it was decided to perform tricuspid transcatheter edge-to-edge repair (T-TEER). Six months later, the patient was readmitted for fever, chills, tachycardia, hypotension, and peripheral hypoperfusion with skin lividity. Blood cultures were positive for methicillin-resistant Staphylococcus epidermidis. Transesophageal echocardiography revealed torrential TR and a large 27- × 23-mm hypoechoic mass attached to a Pascal device. Surgical risk was prohibitive. We opted for medical treatment (daptomycin 12 mg/kg/d and rifampicin 1200 mg daily). The patient developed progressive signs of uncontrolled sepsis and ultimately died.

Infectious endocarditis after TEER is rare, but it has a high mortality rate. There are no reports on how to approach T-TEER-related infective endocarditis.