Infective Endocarditis Following Transcatheter Aortic Valve Replacement

Abstract

Background: No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. Methods: Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. Results: A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2–15] months versus BEV, 5.3 [1.7–11.4] months; P =0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P <0.01), and vegetation location differed according to valve type (stent frame, SEV, 18.6%; BEV, 6.9%; P =0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P =0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04–5.82, P =0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P =0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P =0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died ( P =0.66). Conclusions: The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field.

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

“…Thus a shift towards broader spectrum antibiotics as prophylactic agents is recommended. Regueiro et al, showed no difference in the onset of IE according to the type of implanted device (Regueiro et al, 2019), the same results were observed in our analysis.…”

“…The findings related to survival according to the type of valve are quite controversial, and it is difficult to judge the advantage of selfexpandable over balloon-expandable valves. Regueiro et al (2019) reported no difference in mortality between balloon-expandable and self-expandable valves. Despite this, further studies must be performed.…”

TAVR Explantation: Re-Do Risk Without the Re-Do Sternotomy

“…One limitation, however, is that this study lacked granularity due to using hospital claims data, which do not contain many details on patient comorbidities, specific characteristics of valve explant etiology, and postoperative complications. In comparison, recent studies using TAVR patient registries 4,5 were smaller but had a greater degree of granularity. These studies allowed more detail with respect to surgical complexity and postoperative outcomes, yielding important insights into perioperative management.…”

“…Another recent study by Regueiro et al 5 analyzed infective endocarditis according to TAVR valve type to see whether there were differences among patients who received balloonexpandable valves (BEV) and those who received self-expanding valves (SEV). Data from the multicenter Infectious Endocarditis After TAVR International Registry were analyzed to characterize 245 patients who developed infective endocarditis after TAVR placement.…”

“…These recent studies [3][4][5] provided much needed characterization of the distinct patient population requiring TAVR explant. The data sources from each present unique advantages and disadvantages to each of these studies.…”