Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Dec 10;37(4):e0016823.
doi: 10.1128/cmr.00168-23. Epub 2024 Sep 5.

The emerging challenge of Enterococcus faecalis endocarditis after transcatheter aortic valve implantation: time for innovative treatment approaches

Jaclyn A Cusumano  1 , Andreas P Kalogeropoulos  2 , Mathieu Le Provost  3 , Nicolas R Gallo  1   3 , Steven M Levine  4 , Thomas Inzana  5 , Aikaterini Papamanoli  6
Affiliations
Review

The emerging challenge of Enterococcus faecalis endocarditis after transcatheter aortic valve implantation: time for innovative treatment approaches

Jaclyn A Cusumano et al. Clin Microbiol Rev. .

Abstract

SUMMARYInfective endocarditis (IE) is a life-threatening infection that has nearly doubled in prevalence over the last two decades due to the increase in implantable cardiac devices. Transcatheter aortic valve implantation (TAVI) is currently one of the most common cardiac procedures. TAVI usage continues to exponentially rise, inevitability increasing TAVI-IE. Patients with TAVI are frequently nonsurgical candidates, and TAVI-IE 1-year mortality rates can be as high as 74% without valve or bacterial biofilm removal. Enterococcus faecalis, a historically less common IE pathogen, is the primary cause of TAVI-IE. Treatment options are limited due to enterococcal intrinsic resistance and biofilm formation. Novel approaches are warranted to tackle current therapeutic gaps. We describe the existing challenges in treating TAVI-IE and how available treatment discovery approaches can be combined with an in silico "Living Heart" model to create solutions for the future.

Keywords: Enterococcus faecalis; endocarditis; in silico modeling; transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

J.A.C. has served as an advisor for Shionogi and has received investigator-initiated research funding from Basilea Pharmaceutica. S.M.L. is an employee of Dassault Systèmes. N.R.G. has served as a consultant for Dassault Systèmes. A.P.K., M.L.P., T.I., and A.P. have nothing to disclose.

Figures

Fig 1
Fig 1
Transcatheter aortic valve implantation. The transcatheter aortic valve implantation (TAVI) delivery system is advanced through the femoral artery (A), and retrogradely crosses the native aortic valve (B). The stent-mounted bioprosthetic valve is then deployed either by inflation of a balloon or self-expansion (C). The catheter is then retracted, and the new valve remains firmly anchored to the aortic annulus (D). Figure is courtesy of the Dassault Systemes Living Heart Project. See also Video S1.
Fig 2
Fig 2
Nationwide utilization of TAVI in Denmark per 1,000,000 residents, 2008–2020. Reproduced from reference (10) under a Creative Commons license.
Fig 3
Fig 3
Inflammation post-TAVI and the interaction with bacteria. The interaction of coagulation and the innate immune system coordinate bacterial adhesion to develop the vegetation in IE. Bacteria can adhere to the transcatheter aortic valve implantation (TAVI), which is implanted over the native aortic valve. Location of the bacterial vegetation can vary. Data are not available if the vegetation is formed on the native valve. Planktonic (free floating bacteria) can then detach from the biofilm to cause disseminated infection. Figure was developed by Patrick Lane of ScEYEnce Studios.
Fig 4
Fig 4
The Living Heart Digital Twin. Figure is courtesy of Dassault Systemes’ Living Heart Project. See also Video S1.
See this image and copyright information in PMC

References

    1. Thornhill MH, Dayer MJ, Nicholl J, Prendergast BD, Lockhart PB, Baddour LM. 2020. An alarming rise in incidence of infective endocarditis in England since 2009: why? Lancet 395:1325–1327. doi: 10.1016/S0140-6736(20)30530-4 - DOI - PubMed
    1. Thornhill MH, Jones S, Prendergast B, Baddour LM, Chambers JB, Lockhart PB, Dayer MJ. 2018. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J 39:586–595. doi: 10.1093/eurheartj/ehx655 - DOI - PMC - PubMed
    1. Kolte D, Goldsweig A, Kennedy KF, Abbott JD, Gordon PC, Sellke FW, Ehsan A, Sodha N, Sharaf BL, Aronow HD. 2018. Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States. Am J Cardiol 122:2112–2119. doi: 10.1016/j.amjcard.2018.08.054 - DOI - PubMed
    1. Fernández-Ruiz M, Meije Y, Manuel O, Akan H, Carratalà J, Aguado JM, Delaloye J. 2018. ESCMID study group for infections in compromised hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infectious diseases perspective (Introduction). Clin Microbiol Infect 24:S2–S9. doi: 10.1016/j.cmi.2018.01.029 - DOI - PubMed
    1. Davidson LJ, Davidson CJ. 2021. Transcatheter treatment of valvular heart disease: a review. JAMA 325:2480–2494. doi: 10.1001/jama.2021.2133 - DOI - PubMed

MeSH terms

Substances

LinkOut - more resources