What is the treatment for a Transcatheter Aortic Valve Implantation (TAVI) infection?

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Treatment of Transcatheter Aortic Valve Implantation (TAVI) Infection

TAVI infection should be treated with prolonged intravenous antibiotic therapy and early surgical intervention should be considered in appropriate candidates, following the same principles as prosthetic valve endocarditis management.

Epidemiology and Risk Factors

TAVI-related infective endocarditis (TAVI-IE) is a serious complication with:

  • Incidence of 0.2%-3.1% at 1 year post-implantation 1
  • Overall mortality rate of approximately 38.3% 2
  • Higher risk in males, patients requiring intubation, those with chronic kidney disease, and patients with new pacemaker implantation 2

Diagnosis

Clinical Presentation

  • Fever, new murmur, heart failure symptoms
  • May present with atypical symptoms due to advanced age and comorbidities

Diagnostic Workup

  1. Blood cultures: Multiple sets before initiating antibiotics

  2. Echocardiography:

    • Transthoracic echocardiography (TTE) as first-line imaging
    • Transesophageal echocardiography (TEE) when TTE is inconclusive or to better visualize vegetations

  3. Advanced imaging when echocardiography is inconclusive:

    • CT angiography to assess valve structure and perivalvular complications
    • PET-CT to identify metabolically active infectious foci 1

Treatment Algorithm

1. Antimicrobial Therapy

  • Initial empiric therapy: Target common causative organisms:

    • Enterococci (most common in TAVI-IE)
    • Staphylococcus aureus
    • Coagulase-negative staphylococci 1

  • Duration: Minimum 6 weeks of intravenous antibiotics 1

  • Targeted therapy: Adjust based on culture results and antimicrobial susceptibility testing

2. Surgical Management

  • Consider early surgical intervention for:

    • Heart failure due to valve dysfunction
    • Uncontrolled infection
    • Prevention of embolic events
    • Large vegetations (>10mm)

  • Important note: While >50% of TAVI-IE patients have indications for surgery, only about 16-22% undergo surgical intervention due to high operative risk 2, 3

  • Surgical approach: Explantation of the infected TAVI valve and replacement with a new prosthesis

3. Heart Team Approach

  • Management decisions should be made by a multidisciplinary team including:
    • Cardiologists
    • Cardiac surgeons
    • Infectious disease specialists
    • Imaging specialists

Prevention

  1. Antibiotic prophylaxis:

    • Recommended prior to dental procedures in patients with TAVI 4
    • Follow standard prophylaxis guidelines for prosthetic valves

  2. Infection prevention measures:

    • Maintain good oral hygiene
    • Proper care of dialysis catheters if present
    • Appropriate cutaneous care 3

Prognosis and Outcomes

  • In-hospital mortality: Approximately 25% (range 11-64%) 3
  • Surgical treatment and self-expandable valve devices are associated with lower mortality in TAVI-IE 2

Special Considerations

  • The expanding indication for TAVI to lower-risk populations may change the epidemiology and management of TAVI-IE in the future 3
  • Early recognition and aggressive management are essential to improve outcomes
  • Careful patient selection for surgical intervention is critical given the high-risk profile of many TAVI patients

Remember that TAVI-IE should be managed with the same urgency and comprehensive approach as other forms of prosthetic valve endocarditis, with particular attention to the unique aspects of transcatheter valves.

References

3
Research

Infective endocarditis in patients who have undergone transcatheter aortic valve implantation: a review.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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