Infective endocarditis following transcatheter aortic valve replacement: Diagnostic yield of echocardiography and associated echo-Doppler findings

William R. Miranda, Heidi M. Connolly, Larry M. Baddour, Kashish Goel, Walter R. Wilson, Kevin L. Greason, Charanjit Rihal, David Holmes, Vuyisile T Nkomo, Jae Kuen Oh, Sorin V. Pislaru

Research output: Contribution to journalArticle

Abstract

Background: Studies have suggested the diagnostic yield of echocardiography to be lower in prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) than reported in surgically-implanted valves but data are limited. Methods: We reviewed transthoracic (TTE) and transesophageal (TEE) echo-Doppler findings in 17 patients with PVE (13 definite and 4 possible cases according to modified Duke criteria) after TAVR at Mayo Clinic, Rochester, MN between 2007 and 2016. Results: Median age was 81 years [56; 91] and 5 patients (29%) were female. Median Society of Thoracic Surgery predicted risk of mortality was 8.8%. PVE occurred 197 days [27; 923] after TAVR. Enterococcus faecalis was the most commonly encountered organism (29%). All patients had TEE performed at the time of PVE; TTE was performed in 11 patients. TEE was diagnostic for PVE in 47% of cases and TTE in 18%. TEE was diagnostic in 62% of patients if only definite PVE cases are included. Two patients showed prosthetic obstruction at the time of PVE; obstruction improved with antibiotic therapy in the surviving patient. Conclusion: Standard echocardiography techniques had limited diagnostic performance in patients with TAVR-related PVE. PVE can present as features of TAVR obstruction, thus PVE should also be considered in patients presenting with worsening prosthetic obstruction.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Endocarditis
Echocardiography
Transcatheter Aortic Valve Replacement
Enterococcus faecalis
Thoracic Surgery
Anti-Bacterial Agents
Mortality

Keywords

  • Echocardiography
  • Endocarditis
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Infective endocarditis following transcatheter aortic valve replacement : Diagnostic yield of echocardiography and associated echo-Doppler findings. / Miranda, William R.; Connolly, Heidi M.; Baddour, Larry M.; Goel, Kashish; Wilson, Walter R.; Greason, Kevin L.; Rihal, Charanjit; Holmes, David; Nkomo, Vuyisile T; Oh, Jae Kuen; Pislaru, Sorin V.

In: International Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Miranda, William R. ; Connolly, Heidi M. ; Baddour, Larry M. ; Goel, Kashish ; Wilson, Walter R. ; Greason, Kevin L. ; Rihal, Charanjit ; Holmes, David ; Nkomo, Vuyisile T ; Oh, Jae Kuen ; Pislaru, Sorin V. / Infective endocarditis following transcatheter aortic valve replacement : Diagnostic yield of echocardiography and associated echo-Doppler findings. In: International Journal of Cardiology. 2018.
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AU - Baddour, Larry M.

AU - Goel, Kashish

AU - Wilson, Walter R.

AU - Greason, Kevin L.

AU - Rihal, Charanjit

AU - Holmes, David

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AU - Oh, Jae Kuen

AU - Pislaru, Sorin V.

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AB - Background: Studies have suggested the diagnostic yield of echocardiography to be lower in prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) than reported in surgically-implanted valves but data are limited. Methods: We reviewed transthoracic (TTE) and transesophageal (TEE) echo-Doppler findings in 17 patients with PVE (13 definite and 4 possible cases according to modified Duke criteria) after TAVR at Mayo Clinic, Rochester, MN between 2007 and 2016. Results: Median age was 81 years [56; 91] and 5 patients (29%) were female. Median Society of Thoracic Surgery predicted risk of mortality was 8.8%. PVE occurred 197 days [27; 923] after TAVR. Enterococcus faecalis was the most commonly encountered organism (29%). All patients had TEE performed at the time of PVE; TTE was performed in 11 patients. TEE was diagnostic for PVE in 47% of cases and TTE in 18%. TEE was diagnostic in 62% of patients if only definite PVE cases are included. Two patients showed prosthetic obstruction at the time of PVE; obstruction improved with antibiotic therapy in the surviving patient. Conclusion: Standard echocardiography techniques had limited diagnostic performance in patients with TAVR-related PVE. PVE can present as features of TAVR obstruction, thus PVE should also be considered in patients presenting with worsening prosthetic obstruction.

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