Infective Endocarditis of the TAVI Prosthesis: Emerging New Challenges

A 74-year-old patient presented to the emergency department with aggravating asthenia and persistent fever over the course of the last 2 weeks. He benefited 3 years prior from a self-expandable transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic valve stenosis, as he refused open heart surgery. The blood workup showed leukocytosis and high C-reactive protein levels. However, the microbiological analysis remained negative. During his hospital stay, a transesophageal echocardiogram was performed, which showed thickening of the transcatheter heart valve leaflets and a vegetation of almost 2 cm attached to the stent of the TAVI. A high suspicion of endocarditis was established at this stage even in the absence of microbiological documentation. Surgery showed extensive damage to the prosthesis and consisted of the careful disengagement of the TAVI followed by a successful aortic valve replacement. The microbiological analysis of the excised TAVI identified Streptococcus bovis as the culprit bacteria. The patient fully recovered at the 1-year follow-up. TAVI endocarditis is a source of emerging new challenges, as they are becoming more frequent due to the increase in TAVI procedures, can affect the leaflets and the stent, and can present destructive evolution even with less aggressive bacteria, while remaining amenable to surgical treatment.