Infective endocarditis complicating transcatheter aortic valve implantation

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Device Technology

Background:

• Transcatheter aortic valve implantation (TAVI) is expanding, increasing the potential for TAVI-related infective endocarditis (TAVI-IE).
• TAVI-IE incidence is 0.2%-3.1% at 1 year, often caused by Enterococci and coagulase-negative staphylococci.
• Risk factors include younger age and residual aortic regurgitation, posing diagnostic and therapeutic challenges.

Purpose of the Study:

• To review the current understanding of TAVI-IE, including incidence, risk factors, diagnosis, and management.
• To highlight diagnostic challenges and the emerging role of advanced imaging techniques.
• To discuss treatment strategies and the need for evidence-based guidelines for surgical intervention and prevention.

Main Methods:

• Literature review of TAVI-IE, focusing on incidence, etiology, risk factors, diagnosis, and treatment.
• Analysis of current diagnostic modalities, including echocardiography, multislice computed tomography (MSCT), and 18FDG PET.
• Evaluation of treatment approaches, comparing them to conventional prosthetic valve endocarditis (PVE).

Main Results:

• TAVI-IE incidence is low but expected to rise with broader TAVI use.
• Enterococci and coagulase-negative staphylococci are common pathogens.
• Diagnosis can be difficult, necessitating advanced imaging; treatment mirrors PVE but surgical timing is unclear.

Conclusions:

• TAVI-IE is a growing concern requiring better diagnostic and management strategies.
• Further research is essential for optimizing hybrid imaging, surgical decisions, and preventative measures.
• Evidence-based guidelines are needed to address the complexities of TAVI-IE management.