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An 83-year-old man with coronary heart disease, previous pacemaker implantation due to Mobitz II atrioventricular block, hypertension, hyperuricemia and dementia, presented with dyspnea NYHA III+. Transcatheter aortic valve implantation (TAVI) had been performed 4 months before current admission in another hospital using Portico 27 mm prosthesis (introduced by St. Jude Medical, Minneapolis, Minnesota, today Abbott), where grade II aortic valve regurgitation and paravalvular leakage (PVL) had remained, despite two additional post-dilatations. Despite initial freedom from symptoms, the patient presented at our emergency department with acute cardiac decompensation. Laboratory workup revealed increased inflammatory parameters and blood culture results which were positive for Staphylococcus aureus. Transthoracic and transesophageal echocardiography showed severely impaired systolic left ventricular function with global hypokinesia (ejection fraction; 35%) and high-grade paravalvular aortic valve regurgitation, as well as de novo manifested transvalvular jet. We performed surgical aortic valve replacement (SAVR) because of prosthetic valve endocarditis (PVE).

Surgical aortic valve replacement due to infective endocarditis after transcatheter aortic valve implantation with the self-expanding Portico valve prosthesis