Infective complications after transcatheter aortic valve implantation: results from a single centre

Division of Cardiology, University Medical Centre Utrecht, UMC Utrecht, Heidelberglaan 100, Utrecht, Postbus 85500, 3508 GA, Utrecht, the Netherlands, .
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation (Impact Factor: 2.26). 08/2012; 20(9):360-4. DOI: 10.1007/s12471-012-0303-9
Source: PubMed

ABSTRACT After its first introduction in 2002, transcatheter aortic valve implantation (TAVI) has continuously gained more foothold for the treatment of severe aortic stenosis and is nowadays a viable treatment option for inoperable patients or patients at high risk for conventional surgical aortic valve replacement. Although ideally carried out in a so-called hybrid room, incorporating both the strict hygiene and advanced life support possibilities of the operating theatre and the imaging and percutaneous arsenal of the catheterisation suite, in most centres TAVI is at present performed in the catheterisation laboratory. This may raise concern about an increased risk of infection, since there the criteria that are applied regarding disinfection and sterilisation are not as stringent as those of the operating theatre. Therefore, we retrospectively assessed the number of infective complications in patients undergoing TAVI in the catheterisation lab of our institution. Eleven out of 73 patients developed a postprocedural infection, one of which could be attributed to the procedure itself, being superinfection of a surgical groin cut-down. Our conclusion is that percutaneous aortic valve implantation in a catheterisation laboratory is not associated with an increased risk of infective complications.

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    ABSTRACT: Objectives: This study sought to explore the frequency and prognostic implications of infectious and noninfectious fever following transcatheter aortic valve implantation (TAVI). Methods: We performed a retrospective cohort study including 194 consecutive patients who underwent TAVI at our institution. We identified and characterized all patients who developed fever within the first 72 h following the procedure. We determined the etiology of the fevers (infectious vs. noninfectious) and assessed their impact on in-hospital complications and 1-year mortality. Results: Following TAVI, 65 (33.5%) patients had fever (mean age 83.7 ± 3.8 years, 70.2% female). An infectious etiology was evident in only 17 of the 65 patients (26.1%) with fever, mainly due to pneumonia (52.9%) and a urinary tract infection (41.2%). No significant difference was observed in baseline characteristics, the mean fever temperature/duration, or signs of inflammatory response between infectious and noninfectious fevers. The mean hospital duration was longer (7 ± 4.8 days vs. 4.7 ± 2.4 days, p = 0.01) among patients with an infectious fever; however, fever had no impact on the 1-year mortality rate (5.9 and 4.5%, respectively, p = 0.71). Conclusions: Our study demonstrates that, although fever was a common phenomenon after TAVI, it represented an infectious complication only in a minority of cases. Nevertheless, fever, infectious or not, had no impact on the 1-year mortality rate following TAVI. © 2014 S. Karger AG, Basel.
    Cardiology 01/2014; 127(3):203-210. DOI:10.1159/000356940 · 2.04 Impact Factor
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    ABSTRACT: Fever following transcatheter aortic valve implantation (TAVI) is common and may result in extensive workup, treatment with broad spectrum antibiotics and prolonged hospitalization. Despite these consequences, the prevalence and nature of fever after TAVI, and whether cases of fever could be attributed to an infectious origin have not been studied thoroughly to date. We conducted an observational retrospective analysis of 148 consecutive patients undergoing percutaneous transfemoral TAVI at the Tel-Aviv Medical Center. All patients were treated with antibiotic prophylaxis using first or second generation cephalosporins (or vancomycin upon a beta-lactam allergy) on procedure day. Medical and nursing records were reviewed for the occurrence, extent and origin of fever. Laboratory databases were screened for positive cultures. Fever above 37.5°C occurred in 66 (47%) patients and ≥38.0°C in 27 (19.4%) patients. Most febrile episodes ≥38.0°C were of short duration, lasting less than 8 hours (59.3%, n=16) and occurred in the first 48 hours following procedure (74%, n=22). Bacteremia was found in 2 cases and urinary tract infection in 3 other cases; most pathogens isolated were resistant to prophylactic antibiotic regimen. Unlike prolonged fever, a short febrile episode was not associated with an extended hospital stay or with increased 30 days mortality following TAVI. In conclusion, fever following TAVI occurs frequently, and may represent a non-infectious inflammatory response as it rarely associates with a documented bacterial infection. Therefore, deferring antibiotic therapy in an otherwise well post-TAVI patient with a short febrile episode should be considered, while prolonged and high-grade fever warrants further workup and empiric antibiotic therapy.
    The American journal of cardiology 01/2013; 113(6). DOI:10.1016/j.amjcard.2013.11.063 · 3.43 Impact Factor
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    ABSTRACT: Aims: To describe the characteristics of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and results: This study was performed using the GAMES database, a national prospective registry of consecutive patients with IE in 26 Spanish hospitals. Of the 739 cases of IE diagnosed during the study, 1.3% were post-TAVI IE, and these 10 cases, contributed by five centres, represented 1.1% of the 952 TAVIs performed. Mean age was 80 years. All valves were implanted transfemorally. IE appeared a median of 139 days after implantation. The mean age-adjusted Charlson comorbidity index was 5.45. Chronic kidney disease was frequent (five patients), as were atrial fibrillation (five patients), chronic obstructive pulmonary disease (four patients), and ischaemic heart disease (four patients). Six patients presented aortic valve involvement, and four only mitral valve involvement; the latter group had a higher percentage of prosthetic mitral valves (0% vs. 50%). Vegetations were found in seven cases, and four presented embolism. One patient underwent surgery. Five patients died during follow-up: two of these patients died during the admission in which the valve was implanted. Conclusions: IE is a rare but severe complication after TAVI which affects about 1% of patients and entails a relatively high mortality rate. IE occurred during the first year in nine of the 10 patients.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 02/2015; DOI:10.4244/EIJY15M02_05. · 3.76 Impact Factor

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