Infective endocarditis after transcatheter aortic-valve implantation: Incidence, impact and treatment in a French university hospital

Introduction Infective endocarditis (IE) after Transcatheter aortic-valve implantation (TAVI) is rare but severe complication. Purpose The primary aim of this study was to evaluate incidence, micro-organisms, clinical characteristics, outcomes and management of IE after TAVI. Methods In a single-center, 996 patients were follow-up after TAVI between 2008 and 2018. By appling modified Duke criteria we perform diagnosis of IE. Results We identified 11 cases with « definite diagnosis » representing 1,1% of incidence. Patients characterised by a mean age of 79,6 years. Chronic kidney (5 patients) and diabet (4 patients) was frequent. IE appared after a median of 23,8 months after implantation. Reasons for initial diagnosis was fever (7 patients), heart failure (4 patients), poor condition (4 patients) and septic choc (1 patient). The most frequent causal micro-organisms were Staphylococcus aureus (3 patients) and coagulase-negative staphyloccoci (3 patients). Only one blood culture was negative. Vegetations were demonstrated in 8 cases. Only one patient developed a severe aortic regurgitation. There were no cases of embolism. Five patients had an indication for valve intervention according to the guidelines. After multidisciplinary assessment, medical treatment was the only way in this frailty population. Two patients had a persitent infection. At one year follow-up 7 patients were alive. Conclusion IE is rare but severe complication. In our popultation rate was 1,1% of patients. Staphylococcus aureus and coagulase-negative staphyloccoci were the most represented micro-organisms. Even if valve intervention was necessary, antibiotic treatment was only performed.