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

Lnu, Kriti; Ansari, Shamim Akhtar; Mahto, Shantanu; Gada, Hemal; Mumtaz, Mubashir; Loran, David B.; Theckumparapil, Nikhil J.; Vora, Amit N.

doi:10.1186/s12872-021-02364-0

Cited by 9 publications

(21 citation statements)

References 44 publications

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“…In view of the expanding number of TAVR procedures, rare complications including infective endocarditis have been reported. Complications may manifest as catastrophic aortic root dissection, paravalvular and aortic root abscesses, and intra/paravalvular regurgitation (5). Studies have estimated that the 1-year incidence of prosthetic valve endocarditis (PVE) complicating TAVR (TAVR-PVE) ranges between 0.2% (in the PARTNER 3 trial) and 3.1% (in a Danish cohort study including 509 patients) (4,6).…”

Section: Of 17mentioning

confidence: 99%

“…The diagnosis of TAVR-PVE may be challenging due to the low sensitivity of conventional diagnostic tools and the panoply of non-specific symptoms (5). In light of its high mortality and dreadful complications, clinicians should have a low threshold to consider PVE in patients with a history of TAVR who present with suggestive symptoms and signs to promptly initiate proper management.…”

Section: Of 17mentioning

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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Section: Of 17mentioning

confidence: 99%

Section: Of 17mentioning

confidence: 99%

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

Zakhour¹,

Allaw²,

Kalash³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…One of the specific conditions that poses a challenge on the sensitivity of the modified Duke criteria in general and on echocardiography specifically is TAVI-IE. The decreased sensitivity of echocardiography is a attributed to the location of vegetation and the acoustic shadow of the valve stent [24][25][26]. Recently, a few reports have suggested that FDG PET/CT in this setting can contribute to improved diagnosis [27,28].…”

Section: Fdg Pet/ct In Tavi-iementioning

confidence: 99%

FDG PET/CT in Cardiac Infection: Does It Matter? A Narrative Review

Ghanem-Zoubi

2022

Infect Dis Ther

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The limited performance of echocardiography in specific infectious processes involving the heart led to the search for additional diagnostic tools. Fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) has been proposed for its diagnostic abilities in several infectious diseases including cardiac infections. A literature review of studies evaluating FDG PET/CT in native valve infective endocarditis (IE), prosthetic valve IE, cardiac implantable electrical device (CIED) infection, and left ventricular assist device (LVAD) infection is presented, focusing on studies published in recent years. Overall, in prosthetic valve endocarditis (PVE), FDG PET/CT demonstrate high sensitivity (73–93%) and specificity (80–95%), while in native valve endocarditis (NVE) the sensitivity is very low (22–68%), with high specificity (97–100%) similar to PVE. For CIED, LVAD infection, and transcatheter aortic valve implantation associated endocarditis, data come from small studies and show good diagnostic performance of FDG PET/CT. International guidelines are increasingly recommending FDG PET/CT for the diagnosis of specific conditions of cardiac infections. Beyond the diagnostic performance ability, few studies have evaluated the added benefit of FDG PET/CT in terms of clinical outcomes of patients with suspected cardiac infection. This should be the focus in future studies.

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“…In view of the expanding number of TAVR procedures, rare complications including infective endocarditis have been reported. Complications may manifest as catastrophic aortic root dissection, paravalvular and aortic root abscesses, and intra/paravalvular regurgitation [ 5 ]. Studies have estimated that the 1-year incidence of prosthetic valve endocarditis (PVE) complicating TAVR (TAVR-PVE) ranges between 0.2% (in the PARTNER 3 trial) and 3.1% (in a Danish cohort including 509 patients) [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of TAVR-PVE may be challenging due to the low sensitivity of conventional diagnostic tools and the panoply of non-specific symptoms [ 5 ]. In light of its high mortality and dreadful complications, clinicians should have a low threshold to consider TAVR-PVE in patients who present with suggestive symptoms and signs and should initiate prompt management.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

View full text Add to dashboard Cite

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 among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the 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 the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include 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, the 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.

show abstract

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

Cited by 9 publications

References 44 publications

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

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

FDG PET/CT in Cardiac Infection: Does It Matter? A Narrative Review

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

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