Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review

Abstract

Aortic valve replacement (AVR) successfully treats aortic valve stenosis and aortic regurgitation from aging or bicuspid aortic valves. The procedure intends to restore the obstructed left ventricular outflow tract (LVOT). AVR can be performed surgically (surgical aortic valve replacement (SAVR); open heart) or via transcatheter (transcatheter aortic valve replacement (TAVR)), typically done through a femoral approach as a minimally invasive procedure, allowing for quicker recovery and reduced hospital stays. AVR has many complications, including life-threatening ones, such as infective endocarditis (IE), retarding the recovery process and increasing mortality following surgery. IE is an uncommon and deadly condition that involves multiple organ systems and is caused by bacteremia stemming from a microorganism that enters the bloodstream. Many manifestations are involved in the development of IE, such as fevers, flu-like symptoms, splinter hemorrhages, Osler nodes, abscesses, and vegetations found on the valves at the leaflets. Vegetations and abscesses tend to create further complications, such as stroke and acute kidney injury, as emboli block blood flow, leading to ischemia and damage. This paper aims to evaluate the difference in SAVR- and TAVR-associated IE, as the goal is to elucidate a danger that diminishes the positive effects of either procedure despite its rarity. Studies have been inconclusive in determining whether or not there is a trend, let alone a difference in incident rates. Both procedures share similar risk factors, but SAVR-associated IE is usually caused by Staphylococcus aureus, and studies indicate possibly Enterococcus spp. in TAVR-associated IE. Incident rates of IE are much higher than they should be, whether or not they differ between procedures, and future research needs to consider the pathways and risk factors that can be used to reduce the occurrence of AVR-associated IE.

Keywords: aortic valve replacement; infective endocarditis; percutaneous aortic valve replacement; surgical aortic vavle replacement; transcatheter aortic valve replacement.

Figure 1. Visual representation of the algorithm used for the inclusion and exclusion criteria.

The pathway used for the inclusion and exclusion criteria came from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review. Citation: [11]

Figure 2. Bias risk assessment per GRADE recommendation

GRADE: grading of recommendation, assessments, development, and evaluation