Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement

Abstract

Background Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. Methods Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). Results Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). Conclusions Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

Infective Endocarditis After Transcatheter Aortic Valve Implantation: A Systematic Review

“…6,12 It is important to note that pacemaker lead infection detection has low sensitivity and specificity on cardiac transesophageal echocardiography. Isolated TAVI prosthesis infection was present in only 48% of cases, with periannular complication seen 3.9% of cases as reported by Del Val et al 18…”

“…In a large observational study by Del Val et al of cases of IE after TAVR, fever was present in 74.1%, heart failure in 39.7%, neurological manifestations in 16.7% of cases. 18 It is important to note that patients with IE after TAVI can present with concomitant valvular or other cardiac site or implants infections other than TAVI prosthesis. Brouwer et al reported concomitant mitral valve endocarditis was present in 25% of the cases, and Regueiro et al reported concomitant mitral valve involvement was found in 20%, tricuspid in 11%, and pacemaker lead infection in 15% of cases.…”

How to reduce uncommon but severe transcatheter aortic valve implantation complications: stroke, thrombosis, endocarditis, cognitive decline?

“…22 One-year mortality rates (40–66%), although decreasing, are significantly higher than SAVR IE. 23 In contrast to the aetiology of post-SAVR IE ( Staphylococcus spp ), a frequent causative organism after TAVI is Enterococcus spp , a common groin pathogen, implicating potential sources of bacteraemia. 22 Although TAVI IE is usually complicated with a surgical indication in up to 80%, the rate of surgical treatment is very low (20%).…”

“…22 Although TAVI IE is usually complicated with a surgical indication in up to 80%, the rate of surgical treatment is very low (20%). 23 …”

“…In fact, the incidence of early IE (within 60 days) has more than halved in recent years. 23 Given that the risk of IE is not lower after TAVI in comparison with SAVR, all patients with THV should receive appropriate antibiotic prophylaxis, as indicated in the current guidelines. 24 Routine pre-procedural antibiotic prophylaxis is recommended for all patients undergoing TAVI prior to vascular access to reduce the risk of wound infection and endocarditis 25 but enterococci exhibit a high-level resistance to most commonly used cephalosporins (cefuroxime and cefazoline).…”