The Present and Future
JACC State-of-the-Art Review
Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2022.11.028Get rights and content
Under an Elsevier user license
open archive

Highlights

  • The incidence of IE after TAVR, 0.3 to 2.0 per 100 person-years, is similar to that after SAVR and has remained stable over time, despite improvements in diagnosis and the evolving profile of patients undergoing TAVR.

  • IE after TAVR most commonly involves enterococcal and staphylococcal organisms and is associated with high rates of complications and in-hospital mortality. In addition, patients who survive hospitalization typically exhibit poor long-term prognosis.

  • More research is needed to optimize antibiotic prophylaxis protocols, evaluate novel imaging techniques for diagnosis, identify patients at high risk of adverse outcomes, and clarify the indications for surgical intervention for patients with IE after TAVR.

Abstract

Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.

Key Words

infective endocarditis
prosthetic aortic valve
TAVR
transcatheter aortic valve replacement

Abbreviations and Acronyms

18F-FDG-PET
18F-fluorodeoxyglucose positron emission tomography
BEV
balloon-expandable valve
CT
computed tomography
ESC
European Society of Cardiology
IE
infective endocarditis
PVE
prosthetic valve endocarditis
SAVR
surgical aortic valve replacement
SEV
self-expanding valve
TAVR
transcatheter aortic valve replacement

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

Prof Bernard Prendergast, MD, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.