Recurrence of Prosthetic Aortic Valve Endocarditis After Percutaneous Mechanical Aspiration

BACKGROUND: Prosthetic valve endocarditis is a dreaded complication after transcatheter aortic valve replacement, especially in older patients with multiple comorbidities, who are poor surgical candidates. We describe a case of prosthetic aortic valve endocarditis in a patient who underwent percutaneous mechanical aspiration (PMA) and its sequelae over the following year. CASE SUMMARY: The patient presented with fever and chills after flu and respiratory syncytial virus vaccines and was found to have positive blood cultures for methicillin-resistant Staphylococcus aureus and bioprosthetic aortic valve endocarditis. He was a poor surgical candidate and underwent PMA with an AngioVac device with the development of a perivalvular abscess and pericardial effusion on subsequent admissions. DISCUSSION: PMA is increasingly being used for the treatment of endocarditis, especially right sided, but there is limited evidence on its use in left-sided endocarditis due to high risk of complications. TAKE-HOME MESSAGE: There is a high risk of complications with PMA in left-sided endocarditis, but it can be used as salvage therapy in poor surgical candidates.