Diagnostics and management of infective endocarditis post-transcatheter aortic valve implantation - A systematic review

Abstract

Background: As transcatheter aortic valve implantation (TAVI) has expanded the treatment options to otherwise inoperable patients, it has become as prevalent as surgical aortic valve replacement. TAVI infective endocarditis (IE) has thereby become a feared complication. IE is heterogenous in its presentation, identifying characteristics and diagnostic criteria among these patients is crucial in diagnosing IE. Treatment entails a conventional approach with antibiotics or in combination with surgery. Treatment option for TAVI IE is highly debated in high-risk patients. The primary aim of this systematic review is to find knowledge on how TAVI IE patients are diagnosed and treated as stated in the literature.

Method: Records were searched in MEDLINE and EMBACE. The search strategy is based on how TAVI IE is diagnosed, clinical presentation, treatment, and outcome. EndNote, Rayyan and EPPI-REVIEWER were used in the process of screening and selecting studies. All studies were first assessed by titles and abstracts, then selected articles in full text against the inclusion criteria. All disagreements between the (three) researchers were discussed until agreement.

Results: Final selection process left us with 16 empirical retrospective/prospective studies and 51 case studies, between year 2005-2019.

Conclusion: Diagnosing TAVI IE is based on the modified duke criteria’s (MDC), where pathological findings and clinical judgement are the cornerstone. This review indicates a rise of enterococci as the causative microorganism for TAVI IE, while the common first symptoms recognized are fever, heart failure and systolic murmur. Treatment choice for TAVI IE should be a case-by-case decision based on clinical judgment and managed individually. Studies included in this review indicate that surgical option as a treatment to TAVI IE should be reserved for complicated and life‐threatening cases. Unfortunately, there are not enough studies/data to determine whether surgery or antibiotics are appropriate and when.