Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Negative compared to positive echocardiographic imaging of infective endocarditis after transcatheter aortic valve implantation
N. Mangner1, M. Abdel-Wahab2, T. Gasior3, L. Crusius1, F. Woitek1, S. Haussig1, G. Stachel2, N. Rochor1, A. Schroth1, P. Kiefer4, U. Kappert5, W. Wojakowski3, D. Holzhey6, A. Linke1
1Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; 2Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 3Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katovice, PL; 4Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 5Klinik für Herzchirurgie, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; 6Klinik für Herz- und Thoraxchirurgie, Helios Klinikum Wuppertal - Herzzentrum, Wuppertal;

Introduction: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a severe complication associated with a high mortality. Imaging, particularly transoesophageal echocardiography (TOE), plays a key role in both the diagnosis and management of IE. However, the sensitivity and specificity of TOE is reduced in prosthetic valve endocarditis. We aimed to compare the baseline characteristics and outcome of patients with TAVI-IE according to a negative (IEneg) compared to a positive (IEpos) imaging by TOE.

Methods: Patients developing definite IE after TAVI between 2007 and 2021 at 2 German and 5 Polish centers were included in this analysis. The 1-year mortality was the primary outcome measure of this retrospective multi-center analysis.

Results: Overall, 31 IEneg (20%) and 124 IEpos (80%) were included. Patients were comparable with regard to age (IEneg: 79 (76; 84) vs. IEpos: 81 (77; 84), p=0.29), sex (male: IEneg 58% vs. IEpos 65%, p=0.45) and clinically relevant baseline comorbidities. The rate of self-expanding valves was comparable between IEneg (35.5%) and IEpos (43.5%) (p=0.42). Early IE, i.e. within the first year, occurred in 81% and 74% in IEneg and IEpos, respectively (p=0.46). Symptoms at admission (fever, heart failure, stroke, systemic embolism, and hyporexia) were not significantly different between groups. St. aureus and enterococci were the most prevalent microbiological findings without significant differences between groups. In IEpos, an affected TAVI prosthesis was found in 65% with periannular complications in 30%. Treatment was predominately performed by antibiotics alone; however, IEpos had higher rates of cardiac surgery compared to IEneg (3% vs 29%, p=0.003).

The rate of complications (heart failure, renal failure, septic shock, stroke, systemic embolization, persistent infection) during IE treatment were not significantly different between groups. In-hospital (IEneg: 43% vs. IEpos: 42%, p=0.85) and 1-year mortality (IEneg: 52% vs. IEpos: 56%, p=0.72) was comparable between IEneg and IEpos.

Conclusion: Both IEneg and IEpos are associated with a comparable high in-hospital and 1-year mortality. Continuous bacteraemia in patients having undergone TAVI should trigger immediate antibiotic treatment according to IE guidelines even in initially negative TOE imaging due to a dismal prognosis.


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