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: 1.84). 08/2012; 20(9):360-4. DOI: 10.1007/s12471-012-0303-9
Source: PubMed


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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Available from: Pierfrancesco Agostoni
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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.
    No preview · Article · Jan 2013 · The American journal of cardiology
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    ABSTRACT: In-hospital infection (IHI) after transcatheter aortic valve implantation (TAVI) has received little attention, although it may have a significant effect on outcomes and costs because of prolonged hospital stay. Therefore, the aim of this study was to determine the incidence, type, predictors, and prognostic effects of IHI after TAVI. This study included 298 consecutive patients from 2 centers who underwent TAVI from November 2005 to November 2011. IHI during the hospital stay was defined on the basis of symptoms and signs assessed by the attending physician in the cardiac care unit or medium care unit in combination with all technical examinations performed to confirm infection. IHI after TAVI was observed in 58 patients (19.5%): urinary tract infections in 25 patients (43.1%), pneumonia in 12 patients (20.7%), and access-site infections in 7 patients (12.1%). In 12 patients (20.7%), the site of infection could not be determined, and 2 patients (3.4%) had multiple infection sites. Multivariate analysis revealed that surgical access through the femoral artery was the most important determinant of infection (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.02 to 17.19), followed by perioperative major stroke (OR 3.21, 95% CI 1.01 to 9.52) and overweight (body mass index ≥25 kg/m(2); OR 2.27, 95% CI 1.12 to 4.59). The length of hospital stay in patients with IHIs was 15.0 days (interquartile range 8.0 to 22.0) compared with 7.0 days (interquartile range 4.0 to 10.0) in patients without infections (p <0.0001). Kaplan-Meier estimates of survival at 1 year were 76.6% and 74.4% (log-rank, p = 0.61), respectively. Unadjusted and adjusted OR analysis revealed that IHI did not predict mortality at 30 days (OR 1.27, 95% CI 0.49 to 3.30) or at 1 year (hazard ratio 1.24, 95% CI 0.68 to 2.25). In conclusion, IHI occurred in 19.5% of the patients. Patient-related and, more important, procedure-related variables play a role in the occurrence of infection, indicating that improvements in the execution of TAVI may lead to a reduction of this complication.
    No preview · Article · Apr 2013 · The American journal of cardiology
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is being performed in increasing numbers in recent years, leading to an increase in the variety of complications related to the procedure. In this article, we report a 75-year-old female patient who developed infective endocarditis eight months after TAVI. Timing of surgery and treatment approach may be controversial in patients who underwent TAVI previously since they were already accepted as high risk of cardiac surgery. Therefore, we believe that individual experiences may be beneficial to determine the optimal treatment approach for such complex cases.
    No preview · Article · Sep 2013 · Interactive Cardiovascular and Thoracic Surgery
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