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Transcatheter Aortic Valve Replacement for Aortic Valve Infective Endocarditis: A Systematic Review and Call for

Milos Brankovic1,2, Ashkan Hashemi1, Julia Ansari3

  • 1Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.

Cardiology and Therapy
|April 20, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) may be a viable option for select patients with active aortic valve infective endocarditis (AV-IE) and prohibitive surgical risk. This review highlights TAVR

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Active aortic valve infective endocarditis (AV-IE) poses significant risks, with surgery often declined due to prohibitive surgical risk.
  • Transcatheter aortic valve replacement (TAVR) presents a potential alternative for high-risk patients with AV-IE.
  • TAVR may serve as a bridge-to-surgery or standalone therapy in carefully selected AV-IE cases.

Purpose of the Study:

  • To systematically analyze the existing literature on the application of TAVR in patients with active AV-IE.
  • To evaluate the feasibility and outcomes of TAVR in patients with AV-IE who are not surgical candidates.
  • To identify the role of TAVR as an adjuvant therapy for AV-IE in specific patient populations.

Main Methods:

  • Systematic literature search of PubMed/MEDLINE, Embase, and Cochrane databases (2002-2022).
  • Inclusion criteria focused on studies reporting TAVR use in active AV-IE.
  • Analysis of six eligible studies involving patients with prohibitive surgical risk and AV-IE.

Main Results:

  • Six studies met criteria, all involving male patients (mean age 71 years) with high surgical risk scores (STS 27, EuroSCORE 56).
  • All patients presented with severe or moderate aortic regurgitation and cardiogenic shock, often due to prosthetic valve endocarditis.
  • No in-hospital mortality or myocardial infarction; one stroke occurred within 30 days. Median event-free time was 9 months, with no deaths or reinfections.

Conclusions:

  • TAVR can be considered an adjuvant therapy for selected patients with acute heart failure secondary to AV-IE who have prohibitive surgical risk.
  • Current evidence supports TAVR for acute hemodynamic compromise in AV-IE, not for active infection control or septic embolization.
  • A prospective registry is crucial to further investigate the outcomes of this off-label TAVR indication.

Keywords:
Infective endocarditisProsthetic valve endocarditisTranscatheter aortic valve replacementValve-in-valve

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