Abstract
There is growing interest in infections occurring after transcatheter aortic valve implantation (TAVI). The incidence, and clinical and anatomical features suggest many similarities with prosthetic valve endocarditis. The survival of patients with an infected TAVI prosthesis is generally poor; however, only a minority of them (10%) have undergone treatment with surgical explantation of the infected prosthesis. A literature search was performed using online databases. Papers reporting surgical treatment of TAVI prosthesis infections were retrieved, focusing on pre- and intraoperative characteristics and early outcome. Thirty-seven papers ultimately provided information on 107 patients. Their mean ± standard deviation (SD) age was 76 ± 8 years and 72% were male. The mean ± SD time interval between the TAVI procedure and reoperation was 10 ± 10 months. Annular abscess formation was described in 34% of cases and mitral valve involvement in 31%. All patients underwent TAVI prosthesis explantation and surgical aortic valve replacement; concomitant mitral valve replacement was necessary in 22% of cases. Postoperative in-hospital mortality was 28%. Surgical explantation of infected TAVI prostheses was associated with a high postoperative mortality, although these initial experiences included elderly and high-risk patients. Considering the expansion of TAVI procedures towards younger and lower-risk patients, surgical treatment of TAVI endocarditis may represent the best option for a life-saving procedure.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01494-y) contains supplementary material, which is available to authorized users.
Highlights
Infective endocarditis is still associated with high mortality and morbidity rates [1, 2]
Review papers [18, 57, 58] and analyses of national and international registries [11,12,13,14, 16] have started delineating the common features of transcatheter aortic valve implantation (TAVI) prosthesis infection and have highlighted two important findings: patients with TAVI endocarditis suffer a dismal early outcome with a mortality of 40–70% at 1 year after the diagnosis, and surgical explantation of the infected prosthesis was performed in only 2–14% of cases despite clear indications for surgical intervention in more than 80% of patients [11, 13, 14, 16, 41, 59]
Local complications are common in TAVI endocarditis, as we found evidence of periannular abscess formation and mitral involvement in more than one third of the patients
Summary
Infective endocarditis is still associated with high mortality and morbidity rates [1, 2]. Substantial heterogeneity exists between studies due to differences in population characteristics, risk profile, predisposing factors, microbiological diagnosis and different definitions of infective endocarditis [11,12,13,14,15]. Studies with a longer follow-up time in which large cohorts of patients were analysed, showed that infective endocarditis is not uncommon and reported a cumulative incidence of TAVI prosthesis infection of 5% during the first 5 years [12, 16, 17]. Several risk factors have been associated with TAVI endocarditis [13,14,15, 18,19,20], and alternative imaging tools have been proposed for a prompt and correct diagnosis [11, 14, 21]. Robust evidence for effective treatment strategies that improve the prognosis is still lacking despite a better understanding of the incidence, causes and means of prevention [22]
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