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

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.