Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis

Abstract

The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).

Risk of Infective Endocarditis Associated with Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: A Propensity Score-Based Analysis

“…This assessment was mainly based on previous comorbidities and technical complexity, and it could have influenced our outcomes. Other authors have also noted low surgical rates in patients with post-TAVI IE [ 1 , 9 , 27 ]. Of note, one patient of our cohort with surgical indication who survived the episode was later operated on in a second IE episode with no complications.…”

Surgical treatment of valve endocarditis in high-risk patients and predictors of long-term outcomes

“…We believe there may be a “bias” towards some patients who are considered to be at too high risk for surgery. For instance, patients undergoing transcatheter aortic valve implantation (TAVI) have been found to have a risk for developing infective endocarditis similar to those undergoing surgical aortic valve replacement, and no differences have been reported between these two patient subsets when undergoing surgery/re-surgery 15 – 17 . These findings should prompt us to evaluate operability and the risk of mortality at the time of first intervention.…”

Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions

“…Second, given this study was a narrative review, comparisons across studies did account for variation in sample size that would otherwise be addressed through a meta -analysis. Third, this study did not address all important outcomes that may impact procedural HRQOL, such as infectious endocarditis [52] . Fourth, while traditional cost-effectiveness comparisons have assumed that TAVR serves as a one-to-one replacement for SAVR in all but prohibitive risk patients, the recent expansion of TAVR into low- and moderate-risk individuals means that TAVR populations now include patients who would not have previously been referred for or treated with SAVR [53] .…”