Abstract
BACKGROUND: Prosthetic valve endocarditis (PVE) and aortic dissection are rare but severe complications of transcatheter aortic valve replacement (TAVR), with no standardized surgical approach. CASE SUMMARY: A 74-year-old woman developed PVE 6 months after TAVR with an Evolut PRO+ valve (Medtronic). Echocardiography revealed valve vegetation and perivalvular leakage, and computed tomography showed localized ascending aortic dissection. Emergency surgery involved careful removal of the Evolut PRO+ using sutureless aortic valve replacement and ascending aorta replacement. DISCUSSION: Successful management of TAVR-related PVE with aortic dissection in high-risk patients requires a clear understanding of prosthetic valve characteristics and tailored surgical planning. Techniques such as cold-water explantation and sutureless aortic valve replacement can be particularly useful in minimizing operative risk. TAKE-HOME MESSAGES: This case highlights a reproducible strategy for complex TAVR complications. Cold-water explantation and the snare technique allows safe valve removal, while sutureless aortic valve replacement shortens procedural time, offering practical advantages in high-risk patients.