Abstract
The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).
Highlights
The results from randomized controlled trials (RCTs) and observational/retrospective studies pointed out the evolution of bioprostheses that are used in transcatheter aortic valve replacement (TAVR), as compared to surgical aortic valve replacement (SAVR), in patients with low- to moderate-high risk for surgical intervention and the need for carefully opting between the two procedures [2,3]
A recent meta-analysis showed that patients that were treated with bioprosthetic valves demonstrated a 60% higher risk for infective endocarditis as compared to those who underwent cardiac valve replacement treatment with mechanical prostheses [4]
All of these results can be mainly attributed to the fast identification of the correct anti-microbial therapy— explaining the protective role of early identification of pathogens by means of preoperative blood cultures [14]—and the early indication to surgical intervention before patients’. Such findings were in line with Grubitzsch et al [25], who stated that prompt diagnosis and subsequent treatment were fundamental in reducing morbidity, mortality, and, costs after Prosthetic valve infective endocarditis (PVE) surgery
Summary
Interventional treatment of aortic stenosis is currently based on two different approaches: transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR) [1]. A recent meta-analysis showed that patients that were treated with bioprosthetic valves demonstrated a 60% higher risk for infective endocarditis as compared to those who underwent cardiac valve replacement treatment with mechanical prostheses [4]. Infective endocarditis (IE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity, despite the general improvement in diagnosis, medical, and surgical treatment [5]. Initial evidence showed a similar risk of IE after TAVR or SAVR The aim of this narrative review was to provide a detailed overview about IE in patients who underwent SAVR or TAVR, in order to assess the etiology and current treatments for IE aortic valve intervention and outline the outcome of these patients
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