Author + information
- William Miranda,
- Heidi Connolly,
- Larry Baddour,
- Kashish Goel,
- Walter Wilson,
- Kevin Greason,
- Charanjit Rihal,
- David Holmes,
- Vuyisile Nkomo,
- Mahmoud Ali,
- Jae Oh and
- Sorin Pislaru
Background: The reported incidence of prosthetic valve infective endocarditis (PVE) following transcatheter aortic valve replacement (TAVR) has been variable, ranging from 0.7% to 3.0% per person-years. However, data on PVE after TAVR are limited and the associated echocardiographic and hemodynamic features are still largerly unknown.
Methods: We identified 12 patients diagnosed with PVE (ten definite and two possible cases according to modified Duke criteria) after TAVR at our institution between January 2007 and February 2016. Offline interpretation of transthoracic and transesophageal images was performed by three independent reviewers.
Results: Median age was 81 years and 3 patients (25%) were female. Median Society of Thoracic Surgery predicted risk of mortality was 6.1%. PVE occurred after a median of 183 days [IQR 50; 539] following TAVR. TAVR was performed in the operating room in 10 patients (91%) and transfemoral access was used in 9 patients (75%). Periprocedural information was not available for one patient. Enterococcus faecalis was the most commonly encountered organism (3 patients; 25%). There were four (33%) embolic phenomena and two deaths related to the PVE episode (16%). Transesophageal echocardiography was diagnostic for PVE in 50% of cases, while transthoracic was diagnostic in in 29%. Paravalvular extension of infection was seen in one case and 2 patients had a new mass attached to a pacemaker lead. Moderate perivalvular regurgitation was present in 2 patients (17%) and mild perivalvular regurgitation in 4 (33%); none of them showed worsening in the degree of regurgitation compared to baseline. Two patients showed worsening prosthetic obstruction at the time of PVE with associated thickening of the cusps and lack of mobility. In the surviving patient obstruction improved with antibiotic therapy.
Conclusions: PVE following TAVR was associated with significant morbidity and mortality. Standard echocardiography techniques had limited diagnostic performance. PVE can present as new-onset TAVR obstruction and PVE should be excluded in patients presenting with worsening prosthetic obstruction
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Valvular Heart Disease: Endocarditis
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1103-026
- 2017 American College of Cardiology Foundation