A Case Series of Prosthetic Aortic Valve Dehiscence Caused by Infective Endocarditis and Literature Review

Background: Prosthetic aortic valve dehiscence is a rare but severe complication, most often occurring secondary to infective endocarditis and leading to acute aortic regurgitation. Methods: We report 4 cases of prosthetic aortic valve dehiscence following infective endocarditis that required redo aortic valve replacement. Case presentation: 3 patients showed a characteristic rocking motion on echocardiography suggesting valve dehiscence. All patients underwent redo mechanical aortic valve replacement; intraoperatively, dehiscence involved at least half of the annular circumference, and 3 of 4 cases had a definite annular abscess. In the second patient, no rocking motion or abscess was detected, but culture of the removed prosthetic valve tissue was positive for coagulase-negative staphylococci. One patient died early during hospitalization, and one developed recurrent aortic regurgitation during follow-up. Conclusion: The diagnosis of prosthetic valve endocarditis can be challenging when clinical manifestations are atypical. The Duke–ISCVID 2023 criteria may improve diagnostic sensitivity in complex cases. Emergency surgery is mandatory in acute aortic regurgitation, including redo valve replacement, sutureless valve implantation or homograft replacement.