Incidence and outcomes of infective endocarditis following transcatheter aortic valve implantation

ABSTRACT

Introduction

Prosthetic valve infective endocarditis is a feared and potentially catastrophic complication of valvular intervention. Transcatheter aortic valve implantation has transformed the modern management of aortic stenosis and vastly altered the demographics of those patients undergoing valve replacement.

Areas covered

As a relatively nascent development, what TAVI means for the epidemiology of infective endocarditis, how to identify those patients undergoing the procedure at greatest risk, and how best to prevent and manage the condition remains the subject of fervent research activity. In this review, we appraise relevant contemporary data discussing the incidence, microbiological profiles, associated risk factors and clinical outcomes of infective endocarditis after TAVI.

Expert opinion

Present outcomes are poor, with exceedingly high in-hospital and long-term mortality. Evidence to support surgical management in this patient group is lacking. Prevention is therefore paramount and a logical focus for future research attention.

KEYWORDS:

• Infective endocarditis
• prosthetic valve endocarditis
• aortic valve replacement
• TAVR
• TAVI
• SAVR
• aortic stenosis
• echocardiography
• positron emission tomographic (PET) imaging
• transcatheter valve interventions

Article highlights

• The overall incidence of TAVI-PVE is 0.3-2.1 per 100 person years, with no evidence of a significant difference to patients undergoing SAVR.

• Cases occur comparatively early in the post-procedural period (median onset 5 - 12 months), and the vast majority (>75%) within the first year.

• The microbiological profile varies by study population, yet enterococcus - a pathogen neglected in many antibiotic prophylaxis regimens - is frequently identified.

• Younger, male patients with more co-morbidities (e.g. chronic kidney disease) appear most at risk. Procedural complications (e.g. bleeding) and residual aortic regurgitation are relevant risk factors.

• Present outcomes are poor, with exceedingly high in-hospital and long-term mortality. Evidence to support surgical management in this patient group is lacking.

• Prevention is therefore paramount and a logical focus for future research attention.

Declaration of interest

S Redwood has received speaker fees from Edwards Lifesciences; and has served as an international advisory board member for Medtronic. B Prendergast has received speaker fees from Edwards Lifesciences. C Allen is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/18/48/33745). T Patterson is supported by a National Institute for Health Research Academic Clinical Lectureship. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper is not funded.