Infective Endocarditis in the Transcatheter Aortic Valve Replacement Era: Comprehensive Review of a Rare Complication

In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a revolutionary alternative forsurgical aortic valve replacement (SAVR) for the treatment of severe symptomatic aortic stenosis in patientsat high risk for surgery. Prosthetic aortic valve endocarditis is a serious complication after SAVR with highmorbidity and mortality. Although numerous TAVR procedures have been performed worldwide, infectiveendocarditis (IE) after TAVR was reported in the literature in few cases only and in 0% to 2.3% of patientsenrolled in large TAVR cohorts. Our aim was to review the literature for IE following TAVR and to discussthe diagnostic and management strategies of this rare complication. Ten case reports of IE after TAVR wereidentified, 8 of which were published as case reports and 2 of which were presented in congresses. Infectiveendocarditis occurred in a mean time period of 186 days (median, 90days) after TAVR. Most cases werecharacterized by fever and elevated inflammatory markers. Infective endocarditis after TAVR shared somecommon characteristics with IE after SAVR, yet it has some unique features. Echocardiographic findingsincluded leaflet vegetations, severe mitral regurgitation with rupture of the anterior leaflet, and left ventricleoutflow tract to left atrium fistula. Bacteriologic findings included several atypical bacteria or fungi. Casesof IE were managed either conservatively by antibiotics and/or using surgery, and the overall prognosis waspoor. Infective endocarditis after TAVR deserves prompt diagnosis and treatment. Until further evidence ispresent, IE after TAVR should be managed according to SAVR guidelines with modifications as needed on acase-by-case basis.Prostheticaorticvalveendocarditisisaseriouscomplicationaftersurgicalaorticvalvereplacement(SAVR),occurringinabout 10% to 15% of all cases lifelong with a high morbidityandmortalityrate.