Frequency, pattern, and cause of fever following transfemoral transcatheter aortic valve implantation

Abstract

Fever after transcatheter aortic valve implantation (TAVI) is common and may result in extensive workup, treatment with broad-spectrum antibiotics, and prolonged hospitalization. Despite these consequences, the prevalence and nature of fever after TAVI and whether cases of fever could be attributed to an infectious origin have not been studied thoroughly to date. We conducted an observational retrospective analysis of 148 consecutive patients undergoing percutaneous transfemoral TAVI at the Tel-Aviv Medical Center. All patients were treated with antibiotic prophylaxis using first- or second-generation cephalosporins (or vancomycin upon a β-lactam allergy) on the procedure day. Medical and nursing records were reviewed for the occurrence, extent, and origin of fever. Laboratory databases were screened for positive cultures. Fever ≥37.5°C occurred in 66 patients (47%) and ≥38.0°C in 27 patients (19.4%). Most febrile episodes ≥38.0°C were of short duration, lasting <8 hours (59.3%, n = 16), and occurred in the first 48 hours after procedure (74%, n = 22). Bacteremia was found in 2 cases and urinary tract infection in 3 other cases; most pathogens isolated were resistant to prophylactic antibiotic regimen. Unlike prolonged fever, a short febrile episode was not associated with an extended hospital stay or with increased 30-day mortality rate after TAVI. In conclusion, fever after TAVI occurs frequently and may represent a noninfectious inflammatory response as it rarely associates with a documented bacterial infection. Therefore, deferring antibiotic therapy in an otherwise well post-TAVI patient with a short febrile episode should be considered, whereas prolonged and high-grade fever warrants further workup and empirical antibiotic therapy.