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Sunnerhagen T, Bjarnsholt T, Qvortrup K, Bundgaard H, Moser C. Transcatheter aortic valve implantation (TAVI) prostheses in vitro - biofilm formation and antibiotic effects. Biofilm 2024; 8:100236. [PMID: 39555138 PMCID: PMC11565431 DOI: 10.1016/j.bioflm.2024.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 11/19/2024] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a percutaneous catheter-based treatment of aortic stenosis as an alternative to open heart valve surgery. In cases of TAVI endocarditis, the treatment possibilities may be limited as surgical removal of the infected valve may be associated with a high risk in elderly, comorbid or frail patients. The propensity of bacteria to form a biofilm on foreign material is assumed to be of importance part of the disease process in TAVI endocarditis, but no studies on biofilm formation on TAVI valves have been conducted. We hypothesize that Staphylococcus aureus and Enterococcus faecalis biofilm formation on TAVI valves may have an impact on antibiotic tolerance and non-surgical cure rates. Methods TAVI valves (pieces including part of the metal frame, approximately 1 cm wide) were exposed to either species in vitro in LB-Krebs Ringer medium at 37 °C, with the bacterial count being assessed by culturing of sonicated TAVI pieces and broth at 0, 4, 18 and 24 h after bacterial exposure. Scanning electron microscopy (SEM) was performed. Effects of ampicillin, gentamicin, moxifloxacin, rifampicin (for S. aureus), and ceftriaxone (for E. faecalis) at 5 times minimal inhibitory concentration were tested alone and in combination with ampicillin. Antibiotics were added to biofilm aged 0 or 24 h and the effects assessed. Results Exposure for 15 min established attachment to all of valve pieces. SEM findings were consistent with biofilm formation and suggested lower amounts of bacteria on the metal compared to the tissue part of the TAVI valves. The number of bacteria attached to the TAVI valves increased until 24 h of incubation from less than 10^1 to a level of approximately 10^9 CFU/g. The bacteria became more tolerant to antibiotics on the TAVI valves over time, with the bactericidal effect against 24-h old biofilm being significantly less effective than against 0-h old biofilm depending on antibiotic. Conclusions The results indicate that bacteria can adhere to metal and tissue parts of the TAVI valves within minutes after an exposure which is comparable to transient bacteremia in vivo, and that the bacteria rapidly gain biofilm properties, associated with significantly reduced antibiotic effect.
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Affiliation(s)
- Torgny Sunnerhagen
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Division for Infection Medicine, Department for Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Clinical Microbiology and Infection Control, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Thomas Bjarnsholt
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Qvortrup
- Department of Biomedical Sciences, Core Facility for Integrated Microscopy, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
- Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nappi F. Advancements and Challenges in the Management of Prosthetic Valve Endocarditis: A Review. Pathogens 2024; 13:1039. [PMID: 39770299 PMCID: PMC11728846 DOI: 10.3390/pathogens13121039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 11/21/2024] [Accepted: 11/22/2024] [Indexed: 01/12/2025] Open
Abstract
Prosthetic valve endocarditis (PVE) is the medical term used to describe a focus of infection involving a valvular substitute within the heart. It is a significant concern in the field of cardiology, and the epidemiology of PVE has seen notable developments over the last five decades. The disease currently affects an older demographic and is becoming increasingly prevalent in patients with transcatheter-implanted valves. It is imperative that we urgently address the significant challenges posed by PVE. It is a disease that has a wide range of potential aetiologies, clinical presentations, and courses. In developed countries, Staphylococcus aureus is now the predominant causative organism, resulting in an aggressive form of disease that frequently afflicts vulnerable or elderly populations. However, it is clear that Enterococcus species present a significant challenge in the context of PVE following TAVR procedures, given their elevated prevalence. The 2023 Duke/International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria now include significant developments in microbiological and image-based techniques for diagnostic purposes, specifically the incorporation of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography. These developments unequivocally enhance the diagnostic sensitivity for PVE, while maintaining the specificity. They do so in accordance with the results of studies conducted specifically for the purpose of validation. The lack of rigorous scientific studies and a shortage of funding and resources for research have led to a significant gap in our understanding. Randomized controlled trials could provide invaluable insight and guidance for clinical practice, but they are missing, which represents a major gap. It is clear that there is an urgent need for more research. PVE is a life-threatening condition that must be handled by a multidisciplinary endocarditis team at a cardiac centre in order to improve outcomes. The emergence of innovative surgical techniques has empowered clinicians to steer more patients away from surgical procedures, despite the presence of clear indications for them. A select group of patients can now complete parenteral or oral antimicrobial treatment at home. Additionally, antibiotic prophylaxis is the best option for individuals with prosthetic valves who are going to have invasive dental procedures. These individuals should be given antibiotics beforehand.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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3
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Diego-Yagüe I, Ramos-Martínez A, Muñoz P, Martínez-Sellés M, Machado M, de Alarcón A, Miró JM, Rodríguez-Gacía R, Gutierrez-Díez JF, Hidalgo-Tenorio C, Loeches-Yagüe B, López-Azor JC. Clinical features and prognosis of prosthetic valve endocarditis due to Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2024; 43:1989-2000. [PMID: 39110339 PMCID: PMC11405496 DOI: 10.1007/s10096-024-04848-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/06/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE Staphylococcus aureus prosthetic valve endocarditis (SAPVE) is a serious infection with high mortality. The main objective of this study was to identify factors associated with in-hospital mortality. METHODS From January 2008 to December 2021, consecutive patients from a Spanish cohort of infective endocarditis with a definitive diagnosis of SAPVE were analyzed. RESULTS During the study period, 219 cases of definitive SAPVE were diagnosed, which accounted for 16.7% of a total of 1309 cases of definitive prosthetic valve endocarditis (PVE). Patients presented advanced age and marked comorbidity. There was a higher incidence of persistent bacteremia, septic shock, stroke, and acute kidney injury than in cases of PVE caused by other microorganisms. Methicillin resistance was not associated with differences in clinical presentation, echocardiographic findings, or mortality. Only 50.6% of the patients with surgical indications (88 patients) underwent surgery. Overall, in-hospital mortality was 47.9%. The variables associated with in-hospital mortality were age (OR:1.03, 95% CI: 1.00-1.05; p = 0.016), heart failure (OR:2.86, 95% CI: 1.53-5.32; p = 0.001), acute kidney injury (OR:2.42, 95%CI:1.28-4.58; p = 0.006), stroke (OR:3.53, 95%CI:1.79-6.96; p < 0.001) and surgery indicated but not performed (OR:2.01, 95%CI:1.06-3.8; p = 0.030). On the other hand, the performance of surgery per se in patients with SAPVE, regardless of whether there was a surgical indication according to the guidelines, was not associated with a reduction in in-hospital mortality. CONCLUSIONS SAPVE is characterized by high mortality, which is more marked in patients who present a surgical indication but do not undergo surgery.
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Affiliation(s)
- Itziar Diego-Yagüe
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro, IDIPHISA, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Universidad Autónoma de Madrid, Madrid, Spain.
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Madrid, Madrid, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Marina Machado
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José M Miró
- Servicio de Enfermedades Infecciosas. Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Raquel Rodríguez-Gacía
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Carmen Hidalgo-Tenorio
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, IBS-Granada, Granada, Spain
| | - Belén Loeches-Yagüe
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Jordal S, Kommedal Ø, Haaverstad R, Saeed S, Davidsen ES, Salminen PR, Hufthammer KO, Kittang BR. Epidemiological and microbial trends of infective endocarditis in western Norway: a 7-year prospective observational study. BMC Infect Dis 2024; 24:702. [PMID: 39020296 PMCID: PMC11256475 DOI: 10.1186/s12879-024-09596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. METHODS Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. RESULTS The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. CONCLUSIONS The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.
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Affiliation(s)
- Stina Jordal
- Section of Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Øyvind Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Section of Cardiothoracic Surgery, Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | - Pirjo-Riitta Salminen
- Section of Cardiothoracic Surgery, Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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Hatab T, Zaid S, Thakkar SJ, Bou Chaaya RG, Goel SS, Reardon MJ. Infection of Transcatheter Valvular Devices. Curr Cardiol Rep 2024; 26:767-775. [PMID: 38806975 DOI: 10.1007/s11886-024-02076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology. RECENT FINDINGS Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
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Affiliation(s)
- Taha Hatab
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Syed Zaid
- Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, TX, USA
| | - Samarthkumar J Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Michael J Reardon
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA.
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Papadimitriou-Olivgeris M, Monney P, Frank M, Tzimas G, Tozzi P, Kirsch M, Van Hemelrijck M, Bauernschmitt R, Epprecht J, Guery B, Hasse B. Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC Clinical Criteria for the Diagnosis of Infective Endocarditis in a Multicenter Cohort of Patients With Staphylococcus aureus Bacteremia. Clin Infect Dis 2024; 78:655-662. [PMID: 38168726 PMCID: PMC10954331 DOI: 10.1093/cid/ciae003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The Duke criteria for infective endocarditis (IE) diagnosis underwent revisions in 2023 by the European Society of Cardiology (ESC) and the International Society for Cardiovascular Infectious Diseases (ISCVID). This study aims to assess the diagnostic accuracy of these criteria, focusing on patients with Staphylococcus aureus bacteremia (SAB). METHODS This Swiss multicenter study conducted between 2014 and 2023 pooled data from three cohorts. It evaluated the performance of each iteration of the Duke criteria by assessing the degree of concordance between definite S. aureus IE (SAIE) and the diagnoses made by the Endocarditis Team (2018-23) or IE expert clinicians (2014-17). RESULTS Among 1344 SAB episodes analyzed, 486 (36%) were identified as cases of SAIE. The 2023 Duke-ISCVID and 2023 Duke-ESC criteria demonstrated improved sensitivity for SAIE diagnosis (81% and 82%, respectively) compared to the 2015 Duke-ESC criteria (75%). However, the new criteria exhibited reduced specificity for SAIE (96% for both) compared to the 2015 criteria (99%). Spondylodiscitis was more prevalent among patients with SAIE compared to those with SAB alone (10% vs 7%, P = .026). However, when patients meeting the minor 2015 Duke-ESC vascular criterion were excluded, the incidence of spondylodiscitis was similar between SAIE and SAB patients (6% vs 5%, P = .461). CONCLUSIONS The 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria show improved sensitivity for SAIE diagnosis compared to 2015 Duke-ESC criteria. However, this increase in sensitivity comes at the expense of reduced specificity. Future research should aim at evaluating the impact of each component introduced within these criteria.
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Affiliation(s)
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias Van Hemelrijck
- Department of Cardiac Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Robert Bauernschmitt
- Department of Cardiac Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Panagides V, Cuervo G, Llopis J, Abdel-Wahab M, Mangner N, Habib G, Regueiro A, Mestres CA, Tornos P, Durand E, Selton-Suty C, Ihlemann N, Bruun N, Urena M, Cecchi E, Thiele H, Durante-Mangoni E, Pellegrini C, Eltchaninoff H, Athan E, Søndergaard L, Linke A, Tattevin P, Del Val D, Quintana E, Chu V, Rodés-Cabau J, Miro JM. Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement. Clin Infect Dis 2024; 78:179-187. [PMID: 37552784 DOI: 10.1093/cid/ciad464] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. METHODS Data were collected from the "Infectious Endocarditis after TAVR International" (enrollment from 2005 to 2020) and the "International Collaboration on Endocarditis" (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. RESULTS A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). CONCLUSIONS Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Guillermo Cuervo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology, and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Norman Mangner
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Gilbert Habib
- Cardiology Department, Assistance Publique des Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Ander Regueiro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Pilar Tornos
- Department of Cardiology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Eric Durand
- Department of Cardiology, Normandie University, CHU Rouen, France
| | | | | | - Niels Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Marina Urena
- Cardiology Department, Bichat Hospital, Paris, France
| | - Enrico Cecchi
- Cardiology Department, Hospital Maria Vittoria, Turin, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Axel Linke
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eduard Quintana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian Chu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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8
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Braghieri L, Kaur S, Black CK, Cremer PC, Unai S, Kapadia SR, Mentias A. Endocarditis after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7042. [PMID: 38002656 PMCID: PMC10672470 DOI: 10.3390/jcm12227042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) use is gaining momentum as the mainstay for the treatment of aortic stenosis compared to surgical aortic valve replacement (SAVR). Unfortunately, TAVR-related infective endocarditis (TAVR-IE) is expected to be detected more and more as a result of the ever-expanding indications in younger patients. Given the overall poor prognosis of TAVR-IE, it is imperative that clinicians familiarize themselves with common presentations, major risk factors, diagnostic pitfalls, therapeutic approaches, and the prevention of TAVR-IE. Herein, we review all of the above in detail with the most updated available literature.
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Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Simrat Kaur
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Christopher K. Black
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Paul C. Cremer
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Shinya Unai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
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9
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Slouha E, Rood C, Burle VS, Al-Geizi H, Clunes LA, Kollias TF. Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review. Cureus 2023; 15:e49048. [PMID: 38116334 PMCID: PMC10728577 DOI: 10.7759/cureus.49048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
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.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Catherine Rood
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Venkata Sathya Burle
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Hanin Al-Geizi
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St George's University, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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10
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Hussey PT, Meers JB. Infective Endocarditis After Transcatheter Aortic Valve Replacement: An Update for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00265-3. [PMID: 37211517 DOI: 10.1053/j.jvca.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Patrick T Hussey
- Department of Anesthesiology and Perioperative Medicine,University of Alabama at Birmingham (UAB), Birmingham, AL
| | - J Brad Meers
- Department of Anesthesiology and Perioperative Medicine,University of Alabama at Birmingham (UAB), Birmingham, AL
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11
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Gasior T, Woitek FJ, Schroth A, Abdel-Wahab M, Crusius L, Haussig S, Kiefer P, Scislo P, Huczek Z, Dabrowski M, Witkowski A, Olasinska-Wisniewska A, Grygier M, Protasiewicz M, Hudziak D, Kappert U, Holzhey D, Wojakowski W, Linke A, Mangner N. Impact of Enterococci vs. Staphylococci Induced Infective Endocarditis after Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12051817. [PMID: 36902604 PMCID: PMC10003722 DOI: 10.3390/jcm12051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. METHODS TAVI-IE patients from 2007 to 2021 were included in this analysis. The 1-year mortality was the primary outcome measure of this retrospective multi-center analysis. RESULTS Out of 163 patients, 53 (32.5%) EC-IE and 69 (42.3%) SC-IE patients were included. Subjects were comparable with regard to age, sex, and clinically relevant baseline comorbidities. Symptoms at admission were not significantly different between groups, except for a lower risk for presenting with septic shock in EC-IE than SC-IE. Treatment was performed in 78% by antibiotics alone and in 22% of patients by surgery and antibiotics, with no significant differences between groups. The rate of any complication, in particular heart failure, renal failure, and septic shock during treatment for IE, was lower in EC-IE compared with SC-IE (p < 0.05). In-hospital (EC-IE: 36% vs. SC-IE: 56%, p = 0.035) and 1-year mortality (EC-IE: 51% vs. SC-IE: 70%, p = 0.009) were significantly lower in EC-IE compared with SC-IE. CONCLUSIONS EC-IE, compared with SC-IE, was associated with a lower morbidity and mortality. However, absolute numbers are high, a finding that should trigger further research in appropriate perioperative antibiotic management and improvement of early IE diagnosis in the case of clinical suspicion.
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Affiliation(s)
- Tomasz Gasior
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Felix J. Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Antonia Schroth
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University Hospital, 04289 Leipzig, Germany
| | - Lisa Crusius
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Stephan Haussig
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University Hospital, 04289 Leipzig, Germany
| | - Piotr Scislo
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland
| | - Utz Kappert
- Department of Cardiac Surgery, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Helios University Hospital Wuppertal, 42117 Wuppertal, Germany
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-351-45025297
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12
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Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J. Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:394-412. [PMID: 36697140 DOI: 10.1016/j.jacc.2022.11.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- David Del Val
- Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, CIBERCV, Madrid, Spain; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-L'Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Clínic Barcelona, Barcelona, Spain.
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