1
|
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.
Collapse
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.
| |
Collapse
|
2
|
De Cristofaro J, Sacchi S, Baldetti L, Calvo F, Gramegna M, Pazzanese V, Peveri B, Cianfanelli L, Ajello S, Scandroglio AM. Cat Scratch Endocarditis. JACC Case Rep 2024; 29:102201. [PMID: 38361554 PMCID: PMC10865220 DOI: 10.1016/j.jaccas.2023.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 02/17/2024]
Abstract
We reported a case of blood culture-negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute Bartonella henselae infection, presumably transmitted by cat scratch, documented by positive serologic findings.
Collapse
Affiliation(s)
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Mario Gramegna
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | - Beatrice Peveri
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | | - Silvia Ajello
- Cardiac Intensive Care Unit, San Raffaele University Hospital, Milan, Italy
| | | |
Collapse
|
3
|
Bertolino L, Ramadan MS, Zampino R, Durante-Mangoni E. Infective endocarditis involving MitraClip © devices: a systematic literature review. Infection 2023; 51:1241-1248. [PMID: 37386329 PMCID: PMC10545607 DOI: 10.1007/s15010-023-02067-y] [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: 01/14/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Progress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional surgical prostheses, but little data are currently available. In this systematic review (SR), we summarize current literature regarding the clinical characteristics, management, and outcomes of patients with MitraClip-related infective endocarditis (IE). METHODS We conducted a SR of PubMed, Google Scholar, Embase, and Scopus between January 2003 and March 2022. MitraClip-related IE was defined according to 2015 ESC criteria whereas MitraClip involvement as vegetation on the device or on the mitral valve. Risk of bias was assessed through standardized checklist and potential bias of underestimation cannot be excluded. Data regarding clinical presentation, echocardiography, management, and outcome were collected. RESULTS Twenty-six cases of MitraClip-related IE were retrieved. The median age of patients was 76 [61-83] years with a median EuroScore of 41%. Fever was present in 65.8% of patients followed by signs and symptoms of heart failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time between MitraClip implantation and IE symptom onset of 5 [2-16] months. Staphylococcus aureus was the major causative microorganism (46%). Surgical mitral valve replacement was needed in 50% of patients. A conservative medical approach was considered in the remainder. The overall in-hospital mortality rate was 50% (surgical group: 38.4%; medical group: 58.3%; p = 0.433). CONCLUSION Our results suggest that MitraClip-related IE affects elderly, comorbid patients, is mostly due to Staphylococcus aureus, and has a poor prognosis irrespective of the therapeutic approach. Clinicians must be aware of the features of this new entity among cardiovascular infections.
Collapse
Affiliation(s)
- Lorenzo Bertolino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Mohammad Said Ramadan
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
| |
Collapse
|
4
|
Chourdakis E, Koniari I, Osman N, Kounis N, Hahalis G, Werner N. Late Infective Endocarditis After Transcatheter Mitral Valve Reconstruction (MitraClip): A Case Report and a Review of the Literature. Angiology 2023; 74:205-215. [PMID: 35938650 DOI: 10.1177/00033197221116202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Percutaneous transcatheter mitral valve reconstruction in edge to edge fashion is a well-established option in inoperable or high peri-operative risk patients with severe, symptomatic mitral valve regurgitation. MitraClip in combination with medical treatment improves survival and reduces hospitalization rates compared with optimal medical therapy alone in well selected patients. Clip-associated endocarditis is a rare complication with only few reported cases in the literature. We present a case of late infective endocarditis post Mitral Clip implantation and also review the literature regarding this new rare condition.
Collapse
Affiliation(s)
| | | | - Neriman Osman
- 39643Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | | | | | - Nikos Werner
- 39643Krankenhaus der Barmherzigen Brüder, Trier, Germany
| |
Collapse
|
5
|
Papamanoli A, Rahman T, Kalogeropoulos AP, Lobo Z, Diggs P, Hamik A, Psevdos G. Streptococcus oralis MitraClip endocarditis following a dental procedure: a case report. BMC Infect Dis 2021; 21:884. [PMID: 34454421 PMCID: PMC8403350 DOI: 10.1186/s12879-021-06565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism. Case presentation An 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later. Conclusions Despite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06565-y.
Collapse
Affiliation(s)
- Aikaterini Papamanoli
- Division of Infectious Diseases, Stony Brook University Hospital, Stony Brook, NY, USA.
| | - Tahmid Rahman
- Division of Cardiology, Northport Veterans Affairs Medical Center, Northport, NY, USA
| | | | - Zeena Lobo
- Division of Infectious Diseases, Northport Veterans Affairs Medical Center, NY, Northport, USA
| | - Paul Diggs
- Division of Cardiology, Northport Veterans Affairs Medical Center, Northport, NY, USA
| | - Anne Hamik
- Division of Cardiology, Northport Veterans Affairs Medical Center, Northport, NY, USA
| | - George Psevdos
- Division of Infectious Diseases, Northport Veterans Affairs Medical Center, NY, Northport, USA
| |
Collapse
|
6
|
Périer M, Goursot Y, Russel S, Darrort C, Camalet L, Huang F, Sulman D, Haziza F, Benamer H. [Infective prosthetic endocarditis following percutaneous edge-to-edge mitral valve repair - A Case-report of a successfully medically-treated Staphylococcus epidermidis endocarditis and a literature review]. Ann Cardiol Angeiol (Paris) 2020; 69:392-399. [PMID: 33222820 DOI: 10.1016/j.ancard.2020.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
During the last decade there has been a craze for the percutaneous edge-to-edge mitral valve repair technique with the Mitra-Clip device. This is an alternative treatment to mitral valve surgery for severe mitral regurgitation. In France, this device is aimed at poor candidates for mitral valve surgery. It involves intra-cardiac prosthetic material, which exposes them to the risk of bacterial endocarditis. The consequences of this infective disease can be dramatic, especially for these old patients who suffer from multiple comorbidities. It appears to be a rare but relatively unknown and potentially underestimated complication. The relative data remain scarce and consist of rare case-reports. We report an original case of a Methicilline-sensitive Staphylococcus epidermidis mitral endocarditis following the implantation of clips two months earlier. The patient was then successfully treated with antibiotics. Since the first Mitra-Clip implantation in 2003, only 19 cases of endocarditis have previously been reported. This article proposes a review of theses case-reports and a collection of their relevant clinical, echocardiographic and microbiological characteristics, the delivered therapies and their outcomes. These data contribute to a humble discussion around the main stakes of the disease, which are the prevention, the diagnosis, the involved bacteria's type, the prognosis and the treatments with a focus on the question of the recourse to surgical management.
Collapse
Affiliation(s)
- M Périer
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - Y Goursot
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Russel
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C Darrort
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Camalet
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Huang
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - D Sulman
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Haziza
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - H Benamer
- Service de cardiologie de l'hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, Institut cardiovasculaire Paris Sud (ICPS) Ramsay Générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Membre du Collège de Médecine des Hôpitaux de Paris, France
| |
Collapse
|