Surgical vs TranscatheterEHJFriday, September 25, 2026

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

1 min read·By E. Nolan Beckett, MD·Source: European heart journal. Case reports

From The Valve Wire

A case report of a 64-year-old man with a prior surgical bioprosthetic AVR and healed Enterococcus faecalis prosthetic valve endocarditis who presented in cardiogenic shock with severe prosthetic stenosis, severe central transprosthetic regurgitation, and severe paravalvular leak.

Deemed prohibitive surgical risk, he underwent transfemoral valve-in-valve TAVI with marked hemodynamic improvement, mild residual regurgitation, and no infection recurrence at one year.

The standard-of-care answer for symptomatic bioprosthetic dysfunction complicated by PVE and paravalvular leak remains redo surgery — TAVI in this setting is off-label and carries real concerns: sealing across a paravalvular defect with a device designed to seat within the sewing ring, incomplete debridement of any residual infected tissue, and the durability of a valve-in-valve construct in a previously infected field.

Neither ACC/AHA 2020 nor ESC 2025 endorses ViV-TAVI for PVE-related dysfunction; both reserve transcatheter approaches for degenerated bioprostheses without active infection.

Source Abstract

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.