From the Guidelines
The correct answer is Female sex, which is not a risk factor associated with transcatheter aortic valve replacement (TAVR) prosthetic valve endocarditis. Diabetes, renal failure, and moderate postimplantation aortic valve regurgitation are all established risk factors for developing prosthetic valve endocarditis following TAVR procedures.
- Diabetes impairs immune function and increases susceptibility to infections.
- Renal failure affects the body's ability to clear pathogens and alters immune responses.
- Moderate postimplantation aortic valve regurgitation creates abnormal blood flow patterns that can promote bacterial adherence and colonization of the prosthetic valve. Unlike these conditions, female sex has not been identified as a risk factor for TAVR-associated endocarditis; in fact, some studies suggest males may have a slightly higher risk of this complication, as supported by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Other important risk factors for TAVR-associated endocarditis include orotracheal intubation, vascular complications during the procedure, and prior history of infective endocarditis, as mentioned in the 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. It's worth noting that the 2019 expert consensus document of the Society of Cardiovascular Computed Tomography does not provide direct evidence on the risk factors for TAVR-associated endocarditis, but it highlights the importance of patient and procedure-related factors in increasing the risk of annular rupture, which is a different complication 1. Therefore, based on the most recent and highest quality evidence, female sex is not a risk factor for TAVR-associated endocarditis, and other conditions such as diabetes, renal failure, and moderate postimplantation aortic valve regurgitation should be considered as risk factors for this complication.
From the Research
Risk Factors for Prosthetic Valve Endocarditis after TAVR
The following are risk factors for prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR):
- Male sex, as indicated by studies 2, 3, 4
- Deep sternal wound infection or vascular access-site infection, as reported in 2
- New pacemaker implantation, as found in 4
- Residual aortic regurgitation (≥2 grade), as identified in 4, 5
- Low implanted valve position, as seen in 5
- Implantation of >1 prosthesis, as noted in 5
- Any vascular complication, as reported in 5
- Orotracheal intubation, as found in 4
Factors Not Associated with Increased Risk
The following factors are not associated with an increased risk of prosthetic valve endocarditis after TAVR:
- Female sex, as it is not identified as a risk factor in the studies 2, 3, 4
- Diabetes, as there is no mention of it being a risk factor in the provided studies
- Impaired renal function, as it is not mentioned as a risk factor in the studies 2, 3, 4, 6, 5
- Note that moderate postimplantation aortic valve regurgitation is associated with an increased risk of PVE, but the specific definition of "moderate" may vary across studies. However, based on the information provided, female sex, diabetes, and impaired renal function are not listed as risk factors for prosthetic valve endocarditis after TAVR.