Author + information
- Eran Leshem–Rubinow,
- Sharon Amit,
- Arie Steinvil,
- Eyal Ben– Assa,
- Yigal Abramowitz,
- Gad Keren,
- Shmuel Banai and
- Ariel Finkelstein
The occurrence of fever following transcatheter aortic valve implantation (TAVI) is common and may result in extensive workup, treatment with broad–spectrum antibiotics and prolonged hospitalization. We aimed to assess the prevalence and nature of fever following TAVI, and analyze whether cases of fever were attributed to infection.
An observational retrospective study of the first 141 consecutive patients undergoing TAVI in a 1,200–bed university hospital. All patients received peri–procedural antibiotic prophylaxis with a first or second generation cephalosporin (or vancomycin upon penicillin allergy). Data regarding fever was extracted from medical and nursing records. All microbiologic samples were reviewed and analyzed.
Fever above 37.8c occurred in 32 patients (22.7%) in the first 96 hours following TAVI. A single measure above 37.8c was reported for 19 (59.4%) patients, while 13 (40.6%) patients had at least two measures > 37.8c. Empiric broad–spectrum antibiotic was initiated in 75% of febrile patients, more commonly when fever was high and in all cases when prolonged. Bacteremia was found in 2 febrile patients, both pathogens isolated not covered by the standard prophylactic regimen (Enterococcus Fecalis; ESBL–producing Klebsiella Pneumoniae). Fever was not associated with increased 30 days mortality, yet correlated with several post–procedural complications and prolonged hospitalization.
Fever following TAVI is common, yet rarely associates with microbiologically–proven infection and may actually represent an inflammatory response following valve deployment. Differing antibiotic treatment in the face of a single peri–procedural febrile spike may be considered, yet a protracted course of fever mandates the initiation of broad–spectrum antibiotics.
*First and second authors should be considered as equal contributors.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: TAVR I: Predictors of TAVR Outcomes Including LVEF, Contractile Reserve, BNP, Pulmonary HTN, CA 125, and Fever
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1156M–89
- 2013 American College of Cardiology Foundation