Insights into a Rare Clinical Phenomenon: Isolated Native Valve Endocarditis After Prosthetic Valve Implantation

This review outlines contributors, associations, management, and outcomes in isolated native valve endocarditis after prosthetic valve implantation. A systematic review was performed using four major databases. Isolated native valve endocarditis was compared to prosthetic valve endocarditis in number of cases, age of occurrence, gender distribution, comorbidities, pathogens, prosthetic valve type, left ventricular ejection fraction, treatment type, and mortality. Isolated native valve endocarditis comprised 18.2 % of valvular endocarditis cases after transcatheter implantation. Mean age of this cohort was 79.5 +- 5 years. It was observed in males more than females. Transcatheter implantation was performed majority by transfemoral route. Compared to transcatheter endocarditis, isolated native valve endocarditis was linked to diabetes (39.5 % vs 24.1 %, p = 0.001) and chronic obstructive pulmonary disease (29.4 % vs 19.5 %, p = 0.0157). It was less associated with chronic kidney disease (32.8 % vs 45.3 %, p = 0.012). Gram positive infection rates were comparable between the cohorts. Surgery was less frequent in the former cohort (6.7 % vs 24.3 %, p < 0.05). Mortalities were over 50% after 2 year follow up and linked to heart failure, renal failure, septic shock, and systemic embolism. Isolated native valve endocarditis makes up a measurable proportion of infective endocarditis cases after transcatheter implantation. It is associated with diabetes and pulmonary disease. Given the mortality rate and capacity of isolated native valve endocarditis to manifest on different valves, thorough cardiac evaluation should be considered if infective endocarditis is suspected after transcatheter implantation. Non-mitral isolated native valve endocarditis warrants further investigation. Key Points Question What are the incidence, associations, and outcomes of selective native valve endocarditis following prosthetic valve implantation? Findings This systematic review found that isolated native valve endocarditis was reported most frequently after transcatheter aortic valve implants and particularly in mitral valves. Infrequently, selective native endocarditis is also seen in right heart valves. Diabetes and pulmonary disease are closely associated with selective native endocarditis. Meaning The development of isolated native valve endocarditis should be closely screened for in diabetic and pulmonary patients with transcatheter aortic valve implants. This phenomenon needs further study in non transcatheter populations. Moreover, patients with this rare endocarditis require close long term follow up as delayed mortalities are higher than are early mortalities.