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Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation.
Vassili Panagides1, David Del Val1, Mohamed Abdel-Wahab2
1Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
The American Journal of Cardiology
|April 7, 2022
Summary
Mitral valve infective endocarditis (MV-IE) affects nearly 15% of patients post-transcatheter aortic valve implantation (TAVI). Self-expanding valves and aortic regurgitation increase MV-IE risk, associated with high mortality and infrequent surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Transcatheter aortic valve implantation (TAVI) is a growing procedure.
- Infective endocarditis (IE) post-TAVI is a serious complication.
- Data on mitral valve IE (MV-IE) after TAVI are limited.
Purpose of the Study:
- To evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI.
- To compare MV-IE patients with those experiencing transcatheter heart valve (THV)-only IE.
- To identify factors associated with MV-IE and mortality.
Main Methods:
- Multicenter study using the IE after TAVI International Registry.
- Included 579 patients with definite IE post-TAVI.
- Compared 86 MV-IE patients with 284 THV-IE patients.
Main Results:
- MV-IE occurred in 14.9% of patients.
- Associated factors for MV-IE: self-expanding valves and significant aortic regurgitation.
- Surgical management was less frequent in MV-IE (6.0% vs 21.6%).
- 2-year all-cause mortality was high and similar in both groups (approx. 51%).
- Heart failure and septic shock predicted mortality in MV-IE patients.
Conclusions:
- Approximately 1 in 6 IE cases post-TAVI involve the mitral valve.
- Self-expanding THV and post-discharge aortic regurgitation are risk factors for MV-IE.
- MV-IE patients undergo surgery less often and have a poor prognosis.
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