Infective endocarditis post-transcatheter aortic valve replacement: a systematic review of epidemiology, clinical findings and prognosis

Funding Acknowledgements

Type of funding sources: None.

Background

Transcatheter aortic valve replacement (TAVR) is a minimally invasive, catheter-based procedure to replace calcified narrow aortic valves. Available data on prosthetic valve endocarditis (PVE) post TAVR is limited to small subject populations in the form of case reports and case series. This systematic review aims to evaluate first the incidence of infective endocarditis post TAVR, second the microorganism profile and clinical findings, and third associated mortality/morbidity.

Methods

By adhering to the 2020 PRISMA statement guidelines, a systematic search was conducted to identify studies reporting the incidence of PVE post TAVR. An analysis of patient data including baseline characteristics, clinical findings, and outcomes was conducted. The following keywords were used by applying the BOOLEAN (and/or) logic: infective endocarditis, prosthetic endocarditis, transcatheter aortic valve replacement.

Results

In total, 18 studies were included, comprising 63,604 patients who underwent TAVR. All included studies were observational, i.e., seven multicenter registries, five retrospective studies, three cohort studies, two single-center observational studies, and one prospective study. The analysis yielded that 2.9% (1891) of the included patients suffered from post-TAVR infective endocarditis (IE). The patients with post-TAVR IE had a mean age of 79.2 ± 3.5 years, and 59.6% were males. Nine studies reported theuse of antibiotics for prophylaxis, with β-lactams being the most commonly used. Seventeen studies reported the type of bacteria isolated in cultures; all studies found enterococcus and staphylococcus

species, whereas Streptococcus was isolated in 7 of the 18 studies. Only 3% (60) of the patients had a prior history of IE. Of the reported complications post-TAVR, heart failure was the leading complication, with 0.2% of patients experiencing neurological symptoms, including stroke. The overall mortality rate ofpost-TAVR IE, estimated to be 23%, was alarmingly high.

Conclusion

This synthesis collates a low (2.9%) incidence of infective endocarditis post-TAVR, however high mortality and morbidity by means of heart failure and stroke is documented. Ultimately, appropriate medical care ought to be taken to reduce post-TAVR complications, with cautious and warranted measures of antibiotics prophylaxis to avoid valve complications.