IMR Press / RCM / Volume 21 / Issue 2 / DOI: 10.31083/j.rcm.2020.02.68
Open Access Systematic Review
Infective endocarditis after TAVI: a meta-analysis and systematic review of epidemiology, risk factors and clinical consequences
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1 Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi 700503, Romania
2 'Grigore T. Popa' University of Medicine, Iasi 700115, Romania
3 Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi 700503, Romania
*Correspondence: andrewtarus@gmail.com (Andrei Tarus)
Rev. Cardiovasc. Med. 2020, 21(2), 263–274; https://doi.org/10.31083/j.rcm.2020.02.68
Submitted: 22 April 2020 | Revised: 8 June 2020 | Accepted: 12 June 2020 | Published: 30 June 2020
Copyright: © 2020 Tinica et al. Published by IMR press.
This is an open access article under the CC BY-NC 4.0 license https://creativecommons.org/licenses/by-nc/4.0/.
Abstract

Infective endocarditis (IE) represents one of the most challenging clinical entities, requiring a multidisciplinary approach. The increasing number of surgical and transcatheter heart valves replacements performed annually lead to a higher incidence of prosthetic valve endocarditis. Transcatheter aortic valve implantation (TAVI) brought a new alternative for the treatment of aortic stenosis and a new subgroup of IE with its features. We aimed to compare the incidence of IE in TAVI and surgical valve replacement (SAVR) to identify risk factors for TAVI-IE, evaluate the possible impact on mortality, and clarify the best treatment strategies. A digital scan in PubMed and SCOPUS databases was performed. 68 publications were selected to perform a meta-analysis and systematic review on epidemiology, risk factors, and mortality predictors in TAVI-IE. No significant difference in IE rate was noted between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Male gender, intubation, new pacemaker implantation IE and CKD were correlated with TAVI-IE. Surgical treatment was performed in 22.3% of cases. Overall mortality for the pooled cohort was 38.3%. In a multivariate logistic regression model, surgical treatment and self-expandable device were linked to lower mortality in TAVI-IE. Even if the invasive procedure can trigger bacteremia, exposing the TAVI valve to future infection, no significant difference in IE rate was noted in our analysis between patients with TAVI and those with SAVR for in-hospital, early, mid-term and late IE. Surgical treatment of TAVI-IE can be a viable option in patients with a prohibitive risk score.

Keywords
Aortic valve stenosis
transcatheter aortic valve implantation
surgical aortic valve replacement
infective endocarditis
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