Transcatheter Prosthetic Valve Infective Endocarditis | Journal Scan
What are the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR) or pulmonic valve replacement (TPVR)?
An electronic search was performed to identify studies published between 2000 and 2013 regarding prosthetic valve endocarditis in patients having undergone TAVR or TPVR.
A total of 28 publications describing 60 patients (32 after TAVR, 28 after TPVR) were identified. Most TAVR patients (66% male, 80 ± 7 years of age) had a very high-risk profile (mean logistic EuroSCORE: 30.4 ± 14.0%). In TPVR patients (90% male, 19 ± 6 years of age), prosthetic valve endocarditis was more frequent in the stenotic conduit/valve (61%). The median time between transcatheter valve replacement and infective endocarditis was 5 months (interquartile range 2-9 months). Typical microorganisms were predominant, with a higher incidence of enterococci after TAVR (34.4%), and Staphylococcus aureus after TPVR (29.4%). As many as 60% of patients with prosthetic valve endocarditis after TAVR were managed medically despite related complications such as local extension, embolism, and heart failure in more than 50%. The valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively. In-hospital mortality for TAVR prosthetic valve endocarditis was 34.4%. Most (75%) patients with prosthetic valve endocarditis after TPVR were managed surgically, and in-hospital mortality was 7.1%.
Most cases of prosthetic valve endocarditis after TAVR involved male patients; with a very high-risk profile after TAVR, or underlying stenotic conduit/valve after TPVR. Typical, but different, microorganisms were involved in one-half of the TAVR and TPVR cases. Most TPVR-associated prosthetic valve endocarditis patients were managed surgically, as opposed to TAVR patients; the mortality rate was high, especially in patients following TAVR.
Infective endocarditis is associated with substantial morbidity and mortality in a general population, and risks increase in the setting of a prosthetic valve endocarditis. Patients who undergo TAVR in general have multiple associated comorbidities that preclude or would be associated with high risk during surgical AVR; TAVR-associated endocarditis appears to be, perhaps predictably, very poorly tolerated.
Keywords: Transcatheter Aortic Valve Replacement, Endocarditis, Endocarditis, Bacterial, Embolism, Heart Failure, Hospital Mortality, Incidence, Staphylococcus aureus, Cardiac Surgical Procedures
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