Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following "Healed" Infective Endocarditis

JACC Cardiovasc Interv. 2020 Sep 14;13(17):1983-1996. doi: 10.1016/j.jcin.2020.05.033.

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.

Keywords: TAVR; aortic prosthesis; high surgical risk; infective endocarditis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / microbiology
  • Aortic Valve / surgery*
  • Endocarditis, Bacterial / diagnosis
  • Endocarditis, Bacterial / microbiology
  • Endocarditis, Bacterial / mortality
  • Endocarditis, Bacterial / surgery*
  • Female
  • Heart Valve Diseases / diagnosis
  • Heart Valve Diseases / microbiology
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis / adverse effects
  • Hospital Mortality
  • Humans
  • Male
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / surgery*
  • Recurrence
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Transcatheter Aortic Valve Replacement* / mortality
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents