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. 2015 Feb;8(2):334-346.
doi: 10.1016/j.jcin.2014.09.013.

Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review

Ignacio J Amat-Santos  1 , Henrique B Ribeiro  2 , Marina Urena  2 , Ricardo Allende  2 , Christine Houde  3 , Elisabeth Bédard  2 , Jean Perron  2 , Robert DeLarochellière  2 , Jean-Michel Paradis  2 , Eric Dumont  2 , Daniel Doyle  2 , Siamak Mohammadi  2 , Mélanie Côté  2 , José Alberto San Roman  4 , Josep Rodés-Cabau  5
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Free article

Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review

Ignacio J Amat-Santos et al. JACC Cardiovasc Interv. 2015 Feb.
Free article

Abstract

Objectives: The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR).

Background: Very few data exist on PVE after TVR.

Methods: Studies published between 2000 and 2013 regarding PVE in patients with transcatheter aortic valve replacement (TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified through a systematic electronic search.

Results: A total of 28 publications describing 60 patients (32 TAVRs, 28 TPVRs) were identified. Most TAVR patients (66% male, 80 ± 7 years of age) had a very high-risk profile (mean logistic EuroSCORE: 30.4 ± 14.0%). In TPVR patients (90% male, 19 ± 6 years of age), PVE was more frequent in the stenotic conduit/valve (61%). The median time between TVR and infective endocarditis was 5 months (interquartile range: 2 to 9 months). Typical microorganisms were mostly found with a higher incidence of enterococci after TAVR (34.4%), and Staphylococcus aureus after TPVR (29.4%). As many as 60% of the TAVR-PVE patients were managed medically despite related complications such as local extension, embolism, and heart failure in more than 50% of patients. The valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively. In-hospital mortality for TAVR-PVE was 34.4%. Most TPVR-PVE patients (75%) were managed surgically, and in-hospital mortality was 7.1%.

Conclusions: Most cases of PVE post-TVR involved male patients, with a very high-risk profile (TAVR) or underlying stenotic conduit/valve (TPVR). Typical, but different, microorganisms of PVE were involved in one-half of the TAVR and TPVR cases. Most TPVR-PVE patients were managed surgically as opposed to TAVR patients, and the mortality rate was high, especially in the TAVR cohort.

Keywords: infective endocarditis; transcatheter aortic valve implantation; transcatheter pulmonary valve implantation.

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