Cardiology

Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following "Healed" Infective Endocarditis.


Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following “Healed” Infective Endocarditis.

JACC Cardiovasc Interv. 2020 Sep 14;13(17):1983-1996

Authors: Santos-Martínez S, Alkhodair A, Nombela-Franco L, Saia F, Muñoz-García AJ, Gutiérrez E, Regueiro A, Jimenez-Diaz VA, Rivero F, Romaguera R, Gómez-Herrero J, Rodriguez-Gabella T, Sathananthan J, Gómez Salvador I, Carrasco-Moraleja M, Rodés-Cabau J, Webb J, López J, San Román JA, Amat-Santos IJ

Abstract
OBJECTIVES: This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment.
BACKGROUND: Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended.
METHODS: This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs).
RESULTS: Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure.
CONCLUSIONS: TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.

PMID: 32912458 [PubMed – in process]

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