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Infective endocarditis following transcatheter valvular interventions (transcatheter aortic valve implantation and
Edyta Płońska-Gościniak1, Wojciech Wojakowski2, Marek Deja3
1Department of Cardiology, Pomeranian Medical University, Szczecin, Poland. edytaplonska@life.pl.
Insights
Infective endocarditis (IE) after transcatheter valve procedures is rare but serious. Early diagnosis with advanced imaging and multidisciplinary care are key to improving outcomes for this challenging complication.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Infective endocarditis (IE) is a rare but life-threatening complication following transcatheter valvular interventions.
- The incidence of device-related IE is expected to rise with expanding indications for structural interventions.
- Transcatheter aortic valve implantation (TAVI)-related IE has an incidence of 0.3-2.0 per 100 person-years, with high mortality.
Purpose of the Study:
- To summarize contemporary evidence on the epidemiology, presentation, diagnosis, treatment, and prevention of transcatheter valve-related IE.
- To provide expert opinion on managing this complication.
- To highlight challenges in diagnosis and treatment.
Main Methods:
- Review of contemporary evidence on transcatheter valve-related IE.
- Expert opinion developed by the Association of Valvular Heart Disease and the Association of Cardiovascular Intervention of the Polish Cardiac Society.
- Discussion of diagnostic modalities including echocardiography, cardiac CT, and PET.
Main Results:
- IE after TAVI and transcatheter edge-to-edge repair (TEER) is associated with high mortality.
- Clinical presentation is often atypical, leading to delayed diagnosis.
- Multimodality imaging significantly improves diagnostic accuracy, especially for perivalvular complications.
Conclusions:
- Management requires prolonged antibiotic therapy and consideration of surgical intervention in severe cases.
- Preventive measures like strict asepsis and antibiotic prophylaxis are crucial.
- IE after transcatheter interventions necessitates high clinical vigilance, multidisciplinary management, and individualized strategies.
Abstract:
Infective endocarditis (IE) following transcatheter valvular interventions, including transcatheter aortic valve implantation and transcatheter edge-to-edge repair, is an uncommon but life-threatening complication associated with major diagnostic and therapeutic challenges. As indications for structural interventions continue to expand, the burden of device-related IE is expected to increase. This expert opinion, jointly developed by the Association of Valvular Heart Disease and the Association of Cardiovascular Intervention of the Polish Cardiac Society, summarizes contemporary evidence regarding the epidemiology, clinical presentation, diagnosis, treatment, and prevention of transcatheter valve-related IE. Transcatheter aortic valve implantation-related IE occurs at an estimated incidence of 0.3-2.0 per 100 person-years and is associated with high in-hospital and long-term mortality, whereas transcatheter edge-to-edge repair-related IE is less frequent but similarly associated with poor outcomes. Clinical presentation is frequently atypical, particularly in elderly and in patients with multimorbidity, resulting in delayed diagnosis. Echocardiography remains the first-line imaging modality but is often limited by prosthesis-related artifacts. Multimodality imaging, particularly electrocardiography-gated cardiac computed tomography and in selected cases positron emission tomography, substantially improves diagnostic accuracy and detection, especially of perivalvular complications. Management relies on prolonged pathogen-directed intravenous antibiotic therapy, but surgical intervention should be considered in all patients, with a significant indication for surgery in patients with uncontrolled infection, heart failure, embolic complications, or extensive tissue destruction. Preventive measures, including maintaining strict periprocedural asepsis and targeted antibiotic prophylaxis, remain essential. IE after transcatheter valvular interventions therefore represents a rare but devastating complication requiring high clinical vigilance, multidisciplinary management, and individualized treatment strategies to improve outcomes.
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