Endocarditis After Redo TAVR Managed With Medical Treatment and Later TAVR-in-TAVR-in-TAVR

Infective endocarditis after transcatheter aortic valve replacement (TAVR) is a rare but serious condition, with high morbidity and mortality, often requiring surgery.

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.

This case illustrates the feasibility of prolonged medical management for post-TAVR endocarditis in high-risk patients, with redo TAVR for subsequent SVD.

Lifelong antibiotics and redo TAVRs in case of later SVD may be viable in frail patients, avoiding the risks of surgery.