Transcatheter Aortic Valve Replacement–Associated Infective Endocarditis: Comparison of Early, Intermediate, and Late-Onset Cases

Simrat Kaur, MD; Gursharan Singh Samra, MD; Manpreet Kaur, MD; Nabin K. Shrestha, MD; Steven Gordon, MD; E. Murat Tuzcu, MD; Samir Kapadia, MD; Amar Krishnaswamy, MD; Grant W. Reed, MD, MSc; Rishi Puri, MD, PhD; Lars G. Svensson, MD, PhD; Wael A. Jaber, MD; Brian P. Griffin, MD; Bo Xu, MD

Structural Heart (Apr 2022)

Transcatheter Aortic Valve Replacement–Associated Infective Endocarditis: Comparison of Early, Intermediate, and Late-Onset Cases

Simrat Kaur, MD,
Gursharan Singh Samra, MD,
Manpreet Kaur, MD,
Nabin K. Shrestha, MD,
Steven Gordon, MD,
E. Murat Tuzcu, MD,
Samir Kapadia, MD,
Amar Krishnaswamy, MD,
Grant W. Reed, MD, MSc,
Rishi Puri, MD, PhD,
Lars G. Svensson, MD, PhD,
Wael A. Jaber, MD,
Brian P. Griffin, MD,
Bo Xu, MD

Affiliations

Simrat Kaur, MD: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
Gursharan Singh Samra, MD: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
Manpreet Kaur, MD: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Nabin K. Shrestha, MD: Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
Steven Gordon, MD: Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
E. Murat Tuzcu, MD: Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
Samir Kapadia, MD: Section of Cardiovascular Intervention, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Amar Krishnaswamy, MD: Section of Cardiovascular Intervention, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Grant W. Reed, MD, MSc: Section of Cardiovascular Intervention, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Rishi Puri, MD, PhD: Section of Cardiovascular Intervention, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Lars G. Svensson, MD, PhD: Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Wael A. Jaber, MD: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Brian P. Griffin, MD: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Bo Xu, MD: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Address correspondence to: Bo Xu, MD, FRACP, FACC, FASE, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195

Journal volume & issue: Vol. 6, no. 1
p. 100005

Abstract

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Background: Transcatheter aortic valve replacement–associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate, and late-onset TAVR-IE. Methods: We studied the risk factors, microbiological patterns, and diagnostic and treatment strategies in patients with early (1 year) TAVR-IE. Results: Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019 were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. The mean Society of Thoracic Surgeons risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). 18-fluorodeoxyglucose positron emission tomography aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow-up of 709 ± 453 days. Two patients underwent surgery, of whom one died on day 30 postoperatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate-onset groups, while there was 100% mortality in the late-onset group. Conclusions: In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Understanding timing of TAVR-IE may have important prognostic implications.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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