Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences

Abstract

Infective endocarditis (IE) represents one of the most challenging clinical entities, requiring a multidisciplinary approach. The increasing number of surgical and transcatheter heart valves replacements performed annually lead to a higher incidence of prosthetic valve endocarditis. Transcatheter aortic valve implantation (TAVI) brought a new alternative for the treatment of aortic stenosis and a new subgroup of IE with its features. We aimed to compare the incidence of IE in TAVI and surgical valve replacement (SAVR) to identify risk factors for TAVI-IE, evaluate the possible impact on mortality, and clarify the best treatment strategies. A digital scan in PubMed and SCOPUS databases was performed. 68 publications were selected to perform a meta-analysis and systematic review on epidemiology, risk factors, and mortality predictors in TAVI-IE. No significant difference in IE rate was noted between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Male gender, intubation, new pacemaker implantation IE and CKD were correlated with TAVI-IE. Surgical treatment was performed in 22.3% of cases. Overall mortality for the pooled cohort was 38.3%. In a multivariate logistic regression model, surgical treatment and self-expandable device were linked to lower mortality in TAVI-IE. Even if the invasive procedure can trigger bacteremia, exposing the TAVI valve to future infection, no significant difference in IE rate was noted in our analysis between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Surgical treatment of TAVI-IE can be a viable option in patients with a prohibitive risk score.

Infective Endocarditis Complicated With Septic Embolic Stroke After Transcatheter Aortic Valve Implantation: A Case Report

“…Most frequently isolated causative organisms are gram-positive bacteria such as streptococcus (25.3%), staphylococci (25.3%), and enterococci (24.1%), with Enterococcus spp. as a leading cause in patients who had undergone the transfemoral catheter route [ 9 ]. The all-cause mortality of post-TAVI-IE has been reported to be as considerable at 75% one year after diagnosis [ 2 ].…”

“…Management of post-TAVI-IE and the following septic embolic stroke is a challenging medical dilemma. Persistent infection, uncontrolled embolism, or refractory heart failure may indicate an open-heart surgery [ 5 , 9 ], which was initially avoided in this group of patients who are deemed at high risk to undergo an operation. Therefore, despite having met indications for open-heart surgery, most patients were managed conservatively with antibiotics [ 10 ].…”

“…Previous literature on mortality rates comparing conservative and surgical management is still inconclusive. Some studies suggested the mortality rates are of no significant difference [ 4 , 5 ], while a meta-analysis reported a logistic regression model showing surgical treatment with self-expandable devices to relate to lower mortality [ 9 ]. Proposed management regarding post-TAVI-IE is shown in Table 1 with advantages and disadvantages of each modality, which include surgical intervention, conservative management, and very rarely, a TAVI-in-TAVI regarding post-TAVI-IE management [ 11 ].…”

Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour

“…The most common microorganisms known to cause TAVR-IE are gram-positive cocci, which include Staphylococcus aureus, coagulase negative staphylococci, and enterococci [ 1 – 3 , 6 , 16 – 18 ]. Streptococcus has also been reported to be an important cause of TAVR-IE [ 19 ].…”

Bacteriophages for the Treatment of Graft Infections in Cardiovascular Medicine

“…A meta-analysis and systematic review of infective endocarditis after transcatheter aortic valve repair showed 38% overall mortality [ 23 ]. Autologous vascular grafts offer a natural resistance to infection, but, even with silver or antibiotic coatings, the incidence of Dacron graft infection is reported to be between 0.5% and 6% (depending on the operation, location, and stage of atherosclerosis), with up to 75% mortality and up to 70% limb amputation rates [ 3 , 24 ].…”