As TAVR procedures increase, understanding the unique clinical and microbiological profile of TAVR-associated infective endocarditis is essential due to its high complication rate and dismal prognosis.
Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.
“In this patient population, it's difficult to apply general rules and treatment should involve a tailored, individualized approach. It should involve a specialized endocarditis team trying to decide what the optimal treatment is for each patient, especially considering that both treatment options seem to be associated with an equally poor outcome. The mortality in both groups remains very high.”
Val et al. (Sun,) studied this question.