Elsevier

JACC: Cardiovascular Interventions

Volume 13, Issue 17, 14 September 2020, Pages 1983-1996
JACC: Cardiovascular Interventions

Structural
Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following “Healed” Infective Endocarditis

https://doi.org/10.1016/j.jcin.2020.05.033Get rights and content
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Abstract

Objectives

This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment.

Background

Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended.

Methods

This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs).

Results

Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure.

Conclusions

TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.

Key Words

aortic prosthesis
high surgical risk
infective endocarditis
TAVR

Abbreviations and Acronyms

AV
aortic valve
IE
infective endocarditis
TAVR
transcatheter aortic valve replacement

Cited by (0)

This project was funded by the Instituto de Salud Carlos III (Madrid, Spain) (PI17/02237). Dr. Saia has received speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific. Dr. Regueiro has been a proctor for Abbott. Dr. Romaguera is a proctor for Boston Scientific. Dr. Sathananthan has received consultant and speaker fees from Edwards Lifesciences and Medtronic. Dr. Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Webb has received research funding from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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 JACC: Cardiovascular Interventions author instructions page.