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Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis: Comparison of Early, Intermediate, and
Simrat Kaur1, Gursharan Singh Samra1, Manpreet Kaur2
1Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate, and late-onset TAVR-IE.
Methods:
We studied the risk factors, microbiological patterns, and diagnostic and treatment strategies in patients with early (<60 days), intermediate (60-365 days), and late-onset (>1 year) TAVR-IE.
Results:
Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019 were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. The mean Society of Thoracic Surgeons risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). 18-fluorodeoxyglucose positron emission tomography aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow-up of 709 ± 453 days. Two patients underwent surgery, of whom one died on day 30 postoperatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate-onset groups, while there was 100% mortality in the late-onset group.
Conclusions:
In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Understanding timing of TAVR-IE may have important prognostic implications.
Insights
Transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) most commonly occurs intermediately. Staphylococcus aureus is the main pathogen, and late-onset TAVR-IE has a 100% mortality rate.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Complications
Background:
- Transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) is a rare but serious complication.
- Characteristics of early, intermediate, and late-onset TAVR-IE remain poorly understood.
Purpose of the Study:
- To investigate risk factors, microbiology, diagnosis, and treatment of TAVR-IE.
- To analyze TAVR-IE based on onset timing: early (<60 days), intermediate (60-365 days), and late (>1 year).
Main Methods:
- Retrospective analysis of TAVR-IE cases from an infective endocarditis registry (2007-2019).
- Data collection included patient demographics, Society of Thoracic Surgeons risk score, causative organisms, diagnostic methods (including 18-fluorodeoxyglucose positron emission tomography), management, and outcomes.
Main Results:
- Ten TAVR-IE cases were identified. The majority (60%) presented with intermediate onset.
- Staphylococcus aureus was the most frequent pathogen (66.6%).
- Mortality was 40% overall, with 25% in early/intermediate groups and 100% in the late-onset group. Conservative management was common, with 37.5% survival.
Conclusions:
- Intermediate onset is the most common presentation for TAVR-IE.
- Staphylococcus aureus is the predominant pathogen.
- The timing of TAVR-IE onset significantly impacts prognosis, with late-onset disease being uniformly fatal in this cohort.
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