January 1, 2023Journal of the American College of Cardiology
Infective Endocarditis After Transcatheter Aortic Valve Replacement
Why the study?
Infective endocarditis after TAVR remains a life-threatening complication with an expected increase in at-risk patients, requiring detailed understanding to improve clinical outcomes.
Key Points
- To review the incidence, clinical profile, complications, and management challenges of infective endocarditis developing after transcatheter aortic valve replacement.
- Clinical review examining current evidence regarding infective endocarditis following transcatheter aortic valve replacement (TAVR).
- Incidence rates of infective endocarditis after TAVR remain stable and match rates observed after surgical aortic valve replacement, despite procedural advancements and application in younger populations.
- The condition exhibits unique microbiological characteristics, frequent complications, an uncertain role for surgical intervention, and a dismal overall prognosis.
Structured PICO
P
Population
Patients undergoing transcatheter aortic valve replacement (TAVR)
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.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
GTGilbert TangCardiac surgeon, Mount Sinai Medical Center
“Based on this registry, they are dealing with patients who are pretty sick. This puts the heart team into a bind when you're presented with this situation. Should you try to operate? The patient might not make it out of the operating room or to 30 days. Also, if anyone has had a stroke, taking them to operating room is not a benign undertaking.”
Implication
Warrants individualized management by specialized endocarditis team in IE after TAVR; leaves open benefit of surgery over antibiotics.
Abstract
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.
Discussion
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Cite This Study
Val et al. (2023) studied this question.