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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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Zakhour J, Allaw F, Kalash S, Wehbe S, Kanj SS. Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management. Pathogens 2023; 12:pathogens12020255. [PMID: 36839526 PMCID: PMC9960284 DOI: 10.3390/pathogens12020255] [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] [Received: 01/03/2023] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, the duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.
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Affiliation(s)
- Johnny Zakhour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Fatima Allaw
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Suha Kalash
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Saliba Wehbe
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Souha S. Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
- Correspondence: ; Tel.: +961-1-350000; Fax: +961-1-370814
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De Marzo V, Dettori S, Nicolini LA, Crimi G, Vercellino M, Benenati S, Pescetelli F, Della Bona R, Sarocchi M, Mikulska M, Balbi M, Bassetti M, Porto I. Early infections after successful transcatheter aortic valve replacement are associated with increased short- and long-term mortality: A single-center study. Int J Cardiol 2021; 332:48-53. [PMID: 33785390 DOI: 10.1016/j.ijcard.2021.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We reviewed frequency, microbiological pattern, predictors, and outcomes of early infections following transcatheter aortic valve replacement (TAVR). METHODS Five hundred thirty-nine patients who underwent successful TAVR at a single, high-volume center between January 2014 and December 2019 were enrolled. We defined early infections as occurring within 30-day from TAVR. RESULTS Mean age was 83.5 ± 5.4 years; 230 (42.7%) patients were men. Median follow-up was 12.0 (5.7-18.3) months; 30-day and 1-year death rates were 8/539 (1.5%) and 30/539 (5.6%), respectively. Early infections occurred in 61/539 (11.3%) patients, of whom 2 had infections in two sites. Of the 63 infections, 10 were bloodstream infections (BSI), 5 urinary tract, 27 pulmonary (2 with sepsis), 6 access site infections, 1 enterocolitis, and 14 were clinically diagnosed (no specific site). We observed 31/63 (49.2%) microbiologically-documented infections: Gram+ bacteria were isolated in 12/31 (38.7%), Gram- in 17/31 (54.3%), both Gram+ and Gram- in 2/31 (6.5%); in thirty-two infections no specific pathogen could be isolated (clinically-documented infections). Early infections were more prevalent in patients who died within 30-day (8.2% vs. 0.6%, p < 0.001) or 1-year (14.8% vs. 4.4%, p < 0.001) from TAVR. At multivariable analysis, early infections were independently associated with 30-day (HR: 8.82, 95% CI: 1.11-19.83, p = 0.035) and 1-year mortality (HR: 2.10, 95%CI: 1.28-6.21, p = 0.041). The predictive value for 1-year mortality was maintained even restricting the analysis to documented infections only, or to more severe infections (BSI and pneumonia only) (all p < 0.05). CONCLUSIONS Early infections occur in 1/10th of TAVR and are associated with increased short- and long-term mortality. Whereas a causal relationship between early infections and the risk of death cannot be unequivocally proven, careful surveillance of infected patients may improve TAVR results.
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Affiliation(s)
- Vincenzo De Marzo
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Silvia Dettori
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Ambra Nicolini
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Gabriele Crimi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Vercellino
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Stefano Benenati
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Fabio Pescetelli
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Roberta Della Bona
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Sarocchi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Manrico Balbi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Italo Porto
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
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Kaur S, Misbah Rameez R, Jaber W, Griffin BP, Xu B. Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: A Clinical Update. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1733718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rabel Misbah Rameez
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Brian P. Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
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