Prosthetic valve endocarditis after transcatheter aortic valve implantation: the incidence in a single-centre cohort and reflections on clinical, echocardiographic and prognostic features
2013 | journal article; research paper. A publication with affiliation to the University of Göttingen.
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Prosthetic valve endocarditis after transcatheter aortic valve implantation: the incidence in a single-centre cohort and reflections on clinical, echocardiographic and prognostic features
Puls, M. ; Eiffert, H. ; Huenlich, M. ; Schoendube, F. ; Hasenfuß, G. ; Seipelt, R. & Schillinger, W. (2013)
EuroIntervention, 8(12) pp. 1407-1418. DOI: https://doi.org/10.4244/EIJV8I12A214
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- Authors
- Puls, Miriam ; Eiffert, Helmut ; Huenlich, Mark ; Schoendube, Friedrich ; Hasenfuß, Gerd ; Seipelt, Ralf; Schillinger, Wolfgang
- Abstract
- Aims: Transcatheter aortic valve implantation (TAVI) has recently developed into an accepted alternative to conventional surgery in high-risk patients. According to current data, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. Methods and results: We followed the first 180 consecutive patients who underwent TAVI at our institution to assess safety and efficacy of the procedure. During follow-up (median, 319 days), PVE was seen more frequently than expected. By applying modified Duke criteria five cases could be confirmed (four early-onset and one late-onset PVE, four cases with "definite diagnosis" and one with "possible diagnosis") representing an estimated PVE incidence of 3.4% at one year. Two patients died subsequently. Clinical summaries of all cases are reported and compared to previously published case reports. Conclusions: According to our hypothesis, PVE might be particularly difficult to diagnose after TAVI, whereas TAVI-specific elderly patients might be exceptionally vulnerable. There exists little experience of TEE interpretation in post-TAVI endocarditis which should possess unique characteristics regarding, e.g., valve dehiscence or abscess formation. Therefore, echocardiography as a diagnostic tool often remains initially inconclusive. Because of incongruence between prosthetic device and calcified native aortic valve, some degree of paravalvular leak is common after TAVI. These paravalvular leaks as a nidus for infection, advanced age and abundant comorbidities might predispose TAVI patients for infective endocarditis .
- Issue Date
- 2013
- Publisher
- Europa Edition
- Journal
- EuroIntervention
- ISSN
- 1774-024X