Infectious Endocarditis After Transcatheter Aortic Valve Replacement

Epidemiology and Outcomes

Abstract

With the expansion of the indications of transcatheter aortic valve replacement (TAVR), it is being increasingly performed in older patients with aortic stenosis to improve their quality of life. However, TAVR is not without serious complications. Despite being infrequent, prosthetic valve endocarditis after TAVR is a deadly complication associated with high rates of mortality related to a delayed diagnosis from variable clinical presentations and nonconfirmatory imaging findings. Furthermore, lower intervention rates in these patients, due to their high surgical risk, increases overall mortality. Clinicians should be aware of the differences in presentation and postprocedural anatomical considerations that delay the diagnosis of infectious endocarditis post TAVR. Studies evaluating the role of the procedural setting, implant and access type, and periprocedural antibiotic prophylaxis on the development of prosthetic valve endocarditis, and consensus guidelines that address the appropriate diagnosis and management of prosthetic valve endocarditis after TAVR, are needed.