Redo aortic valve replacement for prosthesis endocarditis in patients previously classified as high or prohibitive risk: a narrative review

Pollari, Francesco; Ziegler, Renate; Nappi, Francesco; Großmann, I.; Steinmann, Jörg; Fischlein, Theodor

doi:10.21037/atm-20-4630

Cited by 4 publications

(4 citation statements)

References 39 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The phenomenon of mutating epidemiology of infective endocarditis in high-income countries is related to substantial progress in the medical and surgical fields [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Therefore, an increase of 25–30% of contemporary cases of IE are acquired in the health sector, either due to the progressive increase in medical care offered during hospitalization or nosocomial admission, or to the possibility of contracting the infection on an outpatient basis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ].…”

Section: Epidemiologymentioning

confidence: 99%

Infective Endocarditis in High-Income Countries

et al. 2022

Self Cite

View full text Add to dashboard Cite

Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Infective Endocarditis in High-Income Countries

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Potential complications include paravalvular abscess formation, stroke, and bleeding, none of which were found in our cohort [ 23 ]. Differences in reported complication rates across studies may be attributed to variations in patients’ clinical characteristics, the surgical techniques employed, and postoperative care protocols [ 40 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Therapy of Infective Prosthesis Endocarditis following TAVI: A Single Center’s Experience

Weymann,

Merzah,

Arjomandi Rad

et al. 2024

Diagnostics

View full text Add to dashboard Cite

Background/Objectives: Infective prosthesis endocarditis (IE) following transcatheter aortic valve implantation (TAVI) presents significant management challenges, marked by high mortality rates. This study reviews our center’s experience with surgical interventions for IE in patients post-TAVI, focusing on outcomes, challenges, and procedural complexities, and providing an overview of the limited literature surrounding this subject. Methods: This study was executed as a comprehensive retrospective analysis, targeting the clinical outcomes of surgical treatment in patients presenting with PVE following TAVI procedures at our institution. From July 2017 to July 2022, we identified five patients who had previously undergone transfemoral transcatheter aortic valve implantation and were later diagnosed with PVE needing surgery, strictly adhering to the modified Duke criteria. Results: All surgical procedures were reported successful with no intra- or postoperative mortality. Patients were predominantly male (80%), with an average age of 76 ± 8.6 years, presenting mostly with dyspnea (NYHA Class II). The mean follow-up was between 121 and 1973 days, with outcomes showing no occurrences of stroke, myocardial infarction, or major bleeding. One patient expired from unrelated causes 3.7 years post-surgery. The operative and postoperative protocols demonstrated effective disease management with enhanced survival and minimal complications. Conclusions: The surgical treatment of IE following TAVI, though challenging, can be successfully achieved with careful patient selection and a multidisciplinary approach. The favorable outcomes suggest that surgical intervention remains a viable option for managing this high-risk patient group. Our study also highlights the scarce literature available on this topic, suggesting an urgent need for more comprehensive research to enhance understanding and improve treatment strategies. Future studies with larger cohorts are needed to further validate these findings and refine surgical strategies for this growing patient population.

show abstract

“…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. Other authors have shown the importance of a multidisciplinary approach, within an Endocarditis team, in evaluating the surgical risk of IE patients and optimizing surgical decisions [ 28 , 29 , 30 ]. We speculate that patients with IE after TAVI should not be discarded for surgery based only on their comorbidity and complexity.…”

Section: Discussionmentioning

confidence: 99%

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

Calderón-Parra

Soto

Oteo-Domínguez

et al. 2023

JCM

View full text Add to dashboard Cite

Background: Infective endocarditis (IE) is a feared complication after surgical aortic valve replacement (SAVR)/transcatheter aortic valve implantation (TAVI). It is not certain which procedure carries a higher risk. Our aim was to assess the risk of IE after SAVR/TAVI. Methods: We conducted an observational study of a prospective cohort, including patients with TAVI/SAVR, from March 2015 to December 2020. IE was defined according to the modified Duke’s criteria. IE occurring during the first 12 months of the procedure was considered early IE, and an episode occurring after 12 months was considered late IE. The propensity score was designed to include variables previously associated with TAVI/SAVR and IE. An inverse probability of treatment weight was generated. Results: In total, 355 SAVR and 278 TAVI were included. Median follow-up, 38 vs. 41 months, p = 0.550. IE occurred in 5 SAVR (1.41%, 95% CI 0.2–2.6) vs. 13 TAVI (4.65%, 95% CI 2.2–7.2), p = 0.016. TAVI patients had more frequent early IE (3.2% vs. 0.3%, p = 0.006). In the PS analyses, IE risk did not differ: OR 0.65, 95% CI 0.32–1.32. Factors associated with TAVI IE included younger age (74y vs. 83y, p = 0.030), complicated diabetes mellitus (38.5% vs. 6.8%, p = 0.002), COPD (46.2% vs. 16.3%, p = 0.015), advanced heart failure (100% vs. 52.9%, p < 0.001), and peripheral arteriopathy (61.5% vs. 26.7%, p = 0.011). Conclusions: Early IE was higher with TAVI, but in the PS analyses, the risk attributable to each procedure was similar. Studies are needed to identify and optimize the risk factors of IE prior to TAVI.

show abstract

Redo aortic valve replacement for prosthesis endocarditis in patients previously classified as high or prohibitive risk: a narrative review

Cited by 4 publications

References 39 publications

Infective Endocarditis in High-Income Countries

Infective Endocarditis in High-Income Countries

Surgical Therapy of Infective Prosthesis Endocarditis following TAVI: A Single Center’s Experience

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

Contact Info

Product

Resources

About