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Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review
Ignacio J Amat-Santos1, Henrique B Ribeiro2, Marina Urena2
1Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
JACC. Cardiovascular Interventions
|February 22, 2015
Summary
Prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR) is rare but serious, particularly in high-risk TAVR patients. TPVR-PVE often requires surgery, while TAVR-PVE has high mortality, underscoring the need for better management strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Research
Background:
- Prosthetic valve endocarditis (PVE) following transcatheter valve replacement (TVR) is an emerging clinical concern.
- Limited data exists on the incidence, characteristics, and outcomes of PVE after TVR procedures.
Purpose of the Study:
- To review the incidence, features, predisposing factors, and outcomes of PVE after transcatheter aortic valve replacement (TAVR) and transcatheter pulmonary valve replacement (TPVR).
- To consolidate existing literature on PVE in the context of TVR.
Main Methods:
- Systematic electronic search of studies published between 2000 and 2013.
- Inclusion of publications detailing PVE in patients who underwent TAVR or TPVR.
- Analysis of patient demographics, clinical presentation, causative microorganisms, management strategies, and outcomes.
Main Results:
- A total of 60 PVE cases (32 TAVR, 28 TPVR) were identified across 28 publications.
- TAVR-PVE patients were older, high-risk males; TPVR-PVE occurred more frequently in stenotic conduits.
- Common pathogens included Enterococci (TAVR) and Staphylococcus aureus (TPVR); in-hospital mortality was high (34.4% for TAVR, 7.1% for TPVR).
Conclusions:
- PVE post-TVR predominantly affects high-risk TAVR patients and those with stenotic conduits in TPVR.
- Distinct microbial profiles were observed between TAVR-PVE and TPVR-PVE.
- Surgical management was more common in TPVR-PVE, with significantly lower mortality compared to TAVR-PVE, which had a high mortality rate.
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