Meta-Analysis Comparing the Incidence of Infective Endocarditis Following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement

Ando, Tomo; Ashraf, Said; Villablanca, Pedro A.; Telila, Tesfaye; Takagi, Hisato; Grines, Cindy L.; Afonso, Luís; Briasoulis, Αlexandros

doi:10.1016/j.amjcard.2018.11.031

Cited by 62 publications

(47 citation statements)

References 20 publications

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“…In-hospital mortality in these patients was 25% and overall mortality 31%. Several other studies have investigated the incidence of PVE post-TAVR, with conflicting results, and reported first-year incidences varying from 0.57 to 3.1% [2,9,[13][14][15][16][17]. When comparing our results with those of previous studies, especially other nationwide registries, we observed lower incidences (cumulative and incidence rate).…”

Section: Discussionsupporting

confidence: 52%

“…PVE is a rare complication, with reported first-year incidences of 0.3-1.8% after surgical aortic valve implantation (SAVR) [2,6,[10][11][12][13], associated with high morbidity and mortality rates [10,13]. For TAVR these incidences vary from 0.57 to 3.1%, based on small studies and a few larger nationwide registries [9,[13][14][15][16][17]. With the shift of TAVR indication towards lower-risk patients, it is of particularly interest how the incidence and outcome of PVE post-TAVR differs from post-SAVR.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

et al. 2020

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Background Transcatheter aortic valve replacement (TAVR) is increasingly being used as an alternative to conventional surgical valve replacement. Prosthetic valve endocarditis (PVE) is a rare but feared complication after TAVR, with reported first-year incidences varying from 0.57 to 3.1%. This study was performed to gain insight into the incidence and outcome of PVE after TAVR in the Netherlands.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

et al. 2020

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“…We found a higher frequency of infective endocarditis (IE) than expected. In a recent meta-analysis with a mean follow-up at 3.4 years, the overall incidence of IE in TAVI was 2.0% [28]. In the present study, five of six patients with IE had a pacemaker or an ICD, which might be associated with an increased risk of IE [29].…”

Section: Discussionmentioning

confidence: 40%

“…Several single-centre studies finding higher incidences suggests that IE is underreported in large studies and registries [30,31]. Diagnosing endocarditis is challenging, and the presentation might be uncharacteristic since the patients are old with comorbidities [28]. As endocarditis can occur later on, longer follow-up than 1 year seems important.…”

Section: Discussionmentioning

confidence: 99%

Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study

et al. 2020

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Aims The objective of this study was to examine baseline frailty status (including cognitive deficits) and important clinical outcomes, to inform shared decision-making in older adults receiving transcatheter aortic valve implantation (TAVI). Methods and resultsWe conducted a prospective, observational study of 82 TAVI patients, recruited 2013 to 2015, with 2-year follow-up. Mean age was 83 years (standard deviation (SD) 4.7). Eighteen percent of the patients were frail, as assessed with an 8-item frailty scale. Fifteen patients (18%) had a Mini-Mental Status Examination (MMSE) score below 24 points at baseline, indicating cognitive impairment or dementia and five patients had an MMSE below 20 points. Mean New York Heart Association (NYHA) class at baseline and 6 months was 2.5 (SD 0.6) and 1.4 (SD 0.6), (p < 0.001). There was no change in mean Nottingham Extended Activities of Daily Living (NEADL) scale between baseline and 6 months, 54.2 (SD 11.5) and 54.5 (SD 10.3) points, respectively, mean difference 0.3 (p = 0.7). At 2 years, six patients (7%) had died, four (5%, n = 79) lived in a nursing home, four (5%) suffered from disabling stroke, and six (7%) contracted infective endocarditis. Conclusions TAVI patients had improvement in symptoms and maintenance of activity of daily living at 6 months. They had low mortality and most patients lived in their own home 2 years after TAVI. Complications like death, stroke, and endocarditis occurred. Some patients had cognitive impairment before the procedure which might influence decision-making. Our findings may be used to develop pre-TAVI decision aids.

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“…Four RCTs (3761 patients, mean follow-up 3.4 years) and one registry (6409 patients, mean follow-up 3.6 years) have reported the incidence of IE following TAVI or SAVR 11 19…”

Section: Epidemiologymentioning

confidence: 99%

Infective endocarditis complicating transcatheter aortic valve implantation

Harding

Cahill

Redwood

et al. 2020

Heart

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Infective endocarditis complicating transcatheter aortic valve implantation (TAVI-IE) is a relatively rare condition with an incidence of 0.2%–3.1% at 1 year post implant. It is frequently caused by Enterococci, Staphylococcus aureus and coagulase negative staphylococci. While the incidence currently appears to be falling, the absolute number of cases is likely to rise substantially as TAVI expands into low risk populations following the publication of the PARTNER 3 and Evolut Low Risk trials. Important risk factors for the development of TAVI-IE include a younger age at implant and significant residual aortic regurgitation. The echocardiographic diagnosis of TAVI-IE can be challenging, and the role of supplementary imaging techniques including multislice computed tomography (MSCT) and positron emission tomography (18FDG PET) is still emerging. Treatment largely parallels that of conventional prosthetic valve endocarditis (PVE), with prolonged intravenous antibiotic therapy and consideration of surgical intervention forming the cornerstones of management. The precise role and timing of cardiac surgery in TAVI-IE is yet to be defined, with a lack of clear evidence to help identify which patients should be offered surgical intervention. Minimising unnecessary healthcare interventions (both during and after TAVI) and utilising appropriate antibiotic prophylaxis may have a role in preventing TAVI-IE, but robust evidence for specific preventative strategies is lacking. Further research is required to better select patients for advanced hybrid imaging, to guide surgical management and to inform prevention in this challenging patient cohort.

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Meta-Analysis Comparing the Incidence of Infective Endocarditis Following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement

Cited by 62 publications

References 20 publications

Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study

Infective endocarditis complicating transcatheter aortic valve implantation

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