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Transcatheter Prosthetic Valve Infective Endocarditis | Journal Scan
Study Questions:
What are the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR) or pulmonic valve replacement (TPVR)?
Methods:
An electronic search was performed to identify studies published between 2000 and 2013 regarding prosthetic valve endocarditis in patients having undergone TAVR or TPVR.
Results:
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%.
Conclusions:
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.
Perspective:
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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