Impact of Prosthetic Valve Endocarditis on Low Risk Undergoing Transcatheter Aortic Valve Replacement
Presenter
Dr. Giorgio A. Medranda, MD, FSCAI, NYU Langone Hospital—Long Island, Glen Cove, NY
Dr. Giorgio A. Medranda, MD, FSCAI1, Toby Rogers, MD2, Cheng Zhang, PhD3, Brian C Case, MD, FSCAI4, Charan Yerasi, M.D.5, Brian Forrestal, MBBS2, Chava Chezar-Azzerad, MD4, Itsik Ben-Dor, MD2, Lowell F. Satler, M.D., FSCAI6 and Ron Waksman, M.D.2, (1)NYU Langone Hospital—Long Island, Glen Cove, NY, (2)MedStar Washington Hospital Center, Washington, DC, (3)MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, (4)MedStar Washington Hospital Center, Brooklyn, NY, (5)MedStar Washington Hospital Center, Elkridge, MD, (6)MedStar Washington Hospital Center, Bethesda, MD
Keywords: Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background
Prosthetic valve endocarditis (PVE) remains a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Understanding PVE in low-risk patients is imperative as indications continue to expand. We sought to describe the mechanisms and incidence of PVE in the LRT (Low Risk TAVR) trials.
Methods
We conducted a cohort study of all patients in the LRT trials, who underwent TAVR from 2016-2020. Included were patients who were deemed to have definitive PVE by the clinical events committee. We report in-hospital outcomes for patients with PVE post-TAVR.
Results
A total of 396 low-risk patients with symptomatic severe aortic stenosis (AS) (72 bicuspid) underwent TAVR in the LRT trials from 2016-2020. PVE occurred in 11 patients a mean of 349 days (±188.9 days) from TAVR. (Figure 1) Early PVE (<365 days) occurred in 5, of which 3 demonstrated evidence of septic emboli to the brain and 2 underwent surgical aortic valve re-intervention. Late PVE (
>365 days) occurred in 6, of which 3 demonstrated evidence of septic embolic to the brain and 1 underwent surgical aortic valve re-intervention. A total of 2 patients with late PVE and septic emboli died. When examining all patients with PVE, 6 had evidence of septic emboli and stroke, of which 2 died, 2 were discharged to a rehabilitation facility and 2 discharged home with home health care.
Conclusions
PVE remains extremely rare but is often fatal in low-risk patients undergoing contemporary TAVR. There were similar rates of early and late PVE in the LRT trials. Septic embolic with evidence of stroke complicated the majority of PVE cases contributing to morbidity and mortality in these patients.
