A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation

Conen, Anna; Stortecky, Stefan; Moreillon, Philippe; Hannan, Margaret M.; Franzeck, Fabian; Jeger, Raban; Widmer, Andreas F.

doi:10.4244/eij-d-19-00993

Cited by 25 publications

(28 citation statements)

References 30 publications

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“…Previously, self-expanding valves have also been identified as a risk factor for TAVI-IE, and further studies of the risk associated with different valve designs are required to resolve this discordance 5. Current expert consensus for prevention of TAVI-IE focuses on antibiotic prophylaxis at the time of implantation, careful patient preparation and sterile implant technique 25…”

Section: Discussionmentioning

confidence: 99%

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

Cahill

Raby

Jewell

et al. 2022

Heart

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ObjectiveTo define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsAll patients who underwent first SAVR or TAVI in England between 2007 and 2016 were identified from the NICOR databases. Hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics database. Approval was obtained from the NHS Research Ethics Committee.Results2057 of 91 962 patients undergoing SAVR developed IE over a median follow-up of 53.9 months—an overall incidence of 4.81 [95% CI 4.61 to 5.03] per 1000 person-years. Correspondingly, 140 of 14 195 patients undergoing TAVI developed IE over a median follow-up of 24.5 months—an overall incidence of 3.57 [95% CI 3.00 to 4.21] per 1000 person-years. The cumulative incidence of IE at 60 months was higher after SAVR than after TAVI (2.4% [95% CI 2.3 to 2.5] vs 1.5% [95% CI 1.3 to 1.8], HR 1.60, p<0.001). Across the entire cohort, SAVR remained an independent predictor of IE after multivariable adjustment. Risk factors for IE included younger age, male sex, atrial fibrillation, and dialysis.ConclusionsIE is a rare complication of SAVR and TAVI. In our population, the incidence of IE was higher after SAVR than after TAVI.

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Section: Discussionmentioning

confidence: 99%

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

Cahill

Raby

Jewell

et al. 2022

Heart

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“…and hence, may not be the most appropriate agent for prophylaxis (58). The rationale behind the use of first or second generation cephalosporins is extrapolated from data on SAVR (59). Nevertheless, compared to SAVR, the likelihood of the involvement of enterococci is much higher (39).…”

Section: Infection Prevention and Controlmentioning

confidence: 99%

“…For the choice of antimicrobial prophylaxis, a single dose of amoxicillin-clavulanate (2.2 g intravenous 0-60 minutes prior to arterial puncture) or alternatively ampicillin-sulbactam (3 g intravenous 0-60 minutes prior to arterial puncture) is more appropriate than cephalosporins, with another dose to be administered if the procedure lasts for more than 2 hours (59). In the setting of beta-lactam allergy or high rates of MRSA, a single dose of IV vancomycin (15 mg/kg to be infused over one to 2 hours) or teicoplanin (9-12 mg/kg) may be administered.…”

Section: Infection Prevention and Controlmentioning

confidence: 99%

“…Combination of vancomycin with a first-or second-generation cephalosporin may offer synergistic activity in settings with very high rates of MRSA (62). In patients with positive MRSA screening or diabetes with a BMI > 30 kg/m 2 , decolonization with chlorhexidine shower bath and nasal mupirocin ointment is recommended 1-6 weeks before the procedure (59). On the other hand, patients with frequent hospitalizations and risk factors for VRE colonization should be screened to optimize prophylactic therapy (63).…”

Section: Infection Prevention and Controlmentioning

confidence: 99%

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Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

Zakhour¹,

Allaw²,

Kalash³

et al. 2023

Preprint

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Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications including young patients. However, as for SAVR, TAVR is also associated with a risk of infectious complications, namely prosthetic valve endocarditis (PVE). As the number of performed TAVR procedure increases, and despite the low incidence of PVE post TAVR, clinicians should be familiar with the associated risk factors and the clinical presentation. Whereas the diagnosis of native valve endocarditis can be straightforward applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, lower sensitivity of the criteria, and low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as S. aureus, coagulase negative staphylococci, Enterococcus spp. and Streptococcus spp. (particularly the viridans group) and, less likely Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

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“…Some concerns have been raised about the adequacy of the sterile conditions in which the transcatheter valves are prepared and finally implanted. A current interim recommendation based on expert opinions, endorsed by the International Society for Cardiovascular Infectious Diseases (ISCVID), deals with infection control in TAVI (24). Owed that IE after TAVI is often related to the TAVI procedure itself and considering the high mortality rate after TAVI, the working group suggests to perform TAVI interventions in either designated catheterization laboratories or hybrid operating rooms.…”

Section: The Point Of View Of the Microbiologist: Infection Preventionmentioning

confidence: 99%

Redo aortic valve replacement for prosthesis endocarditis in patients previously classified as high or prohibitive risk: a narrative review

et al. 2020

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Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (Su-AVR) enabled in the last years many patients at high or prohibitive risk to be treated for their severe symptomatic aortic valve stenosis. As often happens in medicine, new techniques bring not only new hopes, but also new problems. In recent years, alongside the lengthening of the life of these patients treated with TAVI or Su-AVR, cardiologists and cardiac surgeons have had to face the long-term complications associated with the implantation of these devices, such as the prosthetic infective endocarditis. The correct management of prosthesis valve endocarditis after TAVI or Su-AVR in high risk patients, and the possible role of surgery are a matter of debate because pushing the limits of the modern medicine and becoming a new challenge for cardiac surgeons of 21 st century. In this review, we summarized the incidence, characteristics and evidences for this new and controversial problem of the cardiovascular community. Moreover, we investigated the outcomes reported in literature of the conservative and the surgical strategy. Although the reported mortality rate of surgical treatment is high, seems not prohibitive, mostly if compared to conservative medical therapy.The collaborative exchange between cardiologist, cardiac surgeons, clinical microbiologists and expert of imaging is mandatory to face this challenge.

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A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation

Cited by 25 publications

References 30 publications

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

Risk of infective endocarditis after surgical and transcatheter aortic valve replacement

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

Redo aortic valve replacement for prosthesis endocarditis in patients previously classified as high or prohibitive risk: a narrative review

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