From the Research
I strongly recommend searching for case reports on surgical explantation of infected transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) in medical databases like PubMed, Embase, and Cochrane Library to understand management approaches. These case reports are relatively rare but important for understanding management approaches. To find these reports, search using specific terms such as "TAVI infection," "TAVR endocarditis," "transcatheter valve explantation," and "surgical management of infected TAVI" 1.
Key information from existing case reports indicates that infective endocarditis following TAVI/TAVR occurs in approximately 0.3-3.4% of cases, with surgical explantation being necessary in severe cases involving persistent infection, valve dysfunction, heart failure, or large vegetations. The surgical approach typically involves:
- Sternotomy
- Cardiopulmonary bypass
- Removal of the infected prosthesis
- Debridement of infected tissue
- Replacement with a new valve (usually a surgical bioprosthesis) These procedures carry significant mortality risk (20-40%) due to the complex nature of the surgery and the typically frail condition of patients 2.
Early diagnosis using blood cultures, echocardiography, and appropriate antibiotic therapy prior to surgical intervention is crucial for improving outcomes in these challenging cases. Antithrombotic therapy is also an important consideration in patients undergoing TAVI, with single antithrombotic therapy, either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone, generally recommended in those patients without or with atrial fibrillation, respectively 3.
It is essential to individualize the treatment approach based on individual patient characteristics and concurrent procedures. The current guidelines and ongoing clinical trials aim to optimize antithrombotic therapy and improve outcomes for patients undergoing TAVR 4.
In summary, searching for case reports and understanding the management approaches for infected TAVI/TAVR is crucial for improving patient outcomes. Surgical explantation should be considered in severe cases, and early diagnosis and appropriate antibiotic therapy are essential for improving outcomes.