Post-procedural fever after Transcatheter Aortic Valve Implantation (TAVI). A multi-centric study

Fever following transcatheter aortic valve implantation (TAVI) poses a clinical challenge, necessitating a comprehensive diagnostic approach to discern between infectious and non-infectious origins. Despite its minimally invasive nature, TAVI disrupts protective anatomical barriers, leading to an increased risk of infection, as well as to aseptic inflammatory responses. Standardized strategies for the management of these patients are lacking.

We retrospectively analyzed 1074 consecutive patients. Data retrieved from electronic hospital charts included demographics, comorbidities, NYHA functional class, Multidimensional Prognostic Index (MPI), EUROSCORE II and STS risk score, pre- and post-procedural echocardiographic data, and procedural details. Fever was defined as temperature >37.5°C.

Overall, 391 patients (36.4%) experienced at least one episode of fever, in all cases ensuing within the first 2 days after the procedure. Fever lasted only one day (ODF) in most patients (86%). Antibiotic prophylaxis varied, with cefazolin showing the highest efficacy. Management of post-TAVI fever was heterogeneous. Twenty-five percent of febrile patients received an empiric antibiotic therapy, although a presumed site of infection was identified in only 17% of them and just 19 patients (4.9%) had positive blood cultures. Of the 19 patients with positive cultures, 11 had a Gram+ and 8 a Gram-infection. Fever duration, invasive accesses, and clinical suspicion of infection influenced antibiotic initiation. Fever lasting more than one day (MODF) was associated with new-onset atrial fibrillation and prolonged in-hospital stay. Positive blood cultures were linked to higher mortality, especially with Gram-bacteremia. However, patients with short-term fever had a similar mortality to those without fever, highlighting the benign nature of self-limited fever.

Fever is a common complication after TAVI. A watchful waiting strategy is advisable in stable patients without evidence of infection and self-limited episodes of fever, while selected patients may benefit from an aggressive approach.