TAVR After Endocarditis? Contraindication or Last Resort

Transcatheter aortic valve replacement (TAVR) can be an alternative for aortic valves with endocarditis successfully treated with antibiotics, which no longer are severe valve lesions.

At one year, the risk of endocarditis relapse was low and the mortality rate was similar to that of patients without a history of infection.

This aim of this study was to evaluate the safety and the mid-term outcomes of TAVR in a setting of aortic valve infective endocarditis with residual lesion despite antibiotic treatment.

These patients are usually rejected by surgeons and TAVR is not a recommended option for them either.

Researchers retrospectively analyzed 46 patients from 10 sites, who were matched according to sex, EuroSCORE, kidney function, ventricular function, and prosthesis type (among others) so as to compare them with a cohort that was identical except for a history of endocarditis.

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Compared with the general population who underwent TAVR, patients with a history of endocarditis experienced more frequently lesions in other valves and a much higher surgical risk. A previous aortic valve bioprosthesis was also much more frequent (50% vs. 7.5%; p < 0.001).

The mortality rates at 30 days and at one year were 5.6% and 11.1%, respectively. These figures were comparable with those of the control cohort.

III/IV aortic regurgitation was significantly higher in patients with a history of endocarditis (27.9% vs. 10%; p = 0.08), and this was independently associated with higher mortality. There was only one case of endocarditis relapse, but 18% of patients developed sepsis and 43% of patients were re-admitted over the year due to heart failure.

Conclusion

TAVR is a therapeutic alternative for the treatment of residual valvular lesions after endocarditis. At one year, the risk of endocarditis relapse was low and mortality rates were comparable to those for an equal-risk population without a history of endocarditis. Despite all of that, a fourth of these patients developed severe aortic regurgitation and half of them required re-admission.

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

Reference: Sandra Santos-Martínez et al. J Am Coll Cardiol Intv 2020;13:1983–96. https://doi.org/10.1016/j.jcin.2020.05.033.

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