Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: A Clinical Update

Abstract

ABSTRACT Transcatheter aortic valve replacement (TAVR) is a paradigm shift for the management of severe symptomatic aortic stenosis. Infective endocarditis is a dreaded complication, which may potentially occur with TAVR, in a similar fashion to surgical aortic valve prostheses. TAVR infective endocarditis (TAVR-IE) may often be under recognized; therefore, it may be associated with higher morbidity and mortality. Here, we describe the difficulties faced with the diagnosis of TAVR-IE, and elucidate the microbiological profiles, various diagnostic strategies, and management options. Diagnosis of TAVR-IE is challenging, with potentially a lower yield on echocardiography. There is an expanding body of literature on the roles of advanced cardiac imaging techniques such as multidetector cardiac computed tomography (MDCT), Fluoro Deoxy Glucose Positron Emission Tomography (FDG-PET) and labeled leukocyte scintigraphy. Management of these patients should occur in a tertiary care hospital, by a dedicated multi-disciplinary heart valve infective endocarditis team, with the availability for advanced cardiac interventional and surgical procedures. Finally, we analyze the gaps in guidelines for management of prosthetic valve endocarditis in TAVR patients.