SPC365

Transcatheter Aortic Valve Implantation infective endocarditis characterization and outcomes

Session: Comunicações Orais - Sessão 28 - Doença Valvular e Endocardite
Speaker: André Grazina

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.8 Infective Endocarditis - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: André Grazina; Barbara Lacerda Teixeira; Alexandra Castelo; Francisco Barbas Albuquerque; André Ferreira; Ana Raquel Santos; Tiago Mendonça; Inês Rodrigues; Ruben Ramos; António Fiarresga; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong> <span style="background-color:white"><span style="color:black">Transcatheter aortic valve implantation (TAVI) is nowadays a well-established procedure for the treatment of severe aortic stenosis (AS). Infective endocarditis (IE) after TAVI is a rare but potentially fatal complication. Registries report incidences of IE after TAVI from 0% to 14%. Severe infections and peri-valvular involvement seem to be frequent, requiring surgical intervention and valve-in-valve procedures in 11.4% and 6.4% of the cases, respectively. Data on microbiological profile, infection severity, outcomes and appropriate treatment of these patients remains sparse. </span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Objectives:</span></strong><span style="color:black"> This analysis aims to describe the IE incidence after TAVI as well as to characterize the population regarding microbiological profile, infection severity and outcomes.</span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods: </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Retrospective descriptive analysis of patients submitted to TAVI in a single tertiary portuguese center. </span></span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Results:</span></span></strong><span style="background-color:white"><span style="color:black"> 642 consecutive patients underwent TAVI. During the follow-up, 12 patients developed prosthetic aortic valve IE (rate of 1.9%). Baseline characteristics, microbiological profile, clinical manifestations, and outcomes are summarized in table 1. Mean age is 77.7 years old, 83% of the patients are male and comorbidities are frequent with diabetes in 42%, chronic kidney disease in 42%, coronary artery disease in 45%, left ventricular dysfunction in 33% and permanent pacemaker in 42% of the patients. Blood cultures revealed gram-positive bacteria in 42% (staphylococcus in 25%), gram-negative bacteria in 33% and absence of microorganisms in 25% of the cases. Valvular vegetations were present in most of the cases with leaflet destruction and severe aortic regurgitation in 1 patient. 3 patients had peri-prosthetic involvement, all with prosthetic dehiscence and severe leak and 1 with aortic pseudoaneurysm. Embolic events occurred in 25% of the patients, mainly to central nervous system. The median time to development of IE after TAVI was 114 days, with 4 patients developing IE less than one month after TAVI. Despite the relative high rates of severe infection, with peri-valvular involvement and embolic phenomenon, none of the patients was accepted to surgical treatment and valve-in-valve procedures was not attempted. 1 patient with severe leak was submitted to percutaneous leak closure with technical success. All the remaining underwent antibiotic treatment alone. The mortality rates were 17% at 30 days and 50% at 1 year. </span></span></span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Infective endocarditis remains a rare but severe complication of TAVI procedures, with high mortality rates. Patients are often old, frail and unsuitable for surgical intervention. Efforts should be made to better prevent IE and to define appropriate antibiotic regimens in these patients. The use of valve-in-valve procedures to treat prosthetic dehiscence with leak is lacking data. </span></span></span></span></p>