TAVR Surgery Linked To Increased Endocarditis And Risk of Death: Study

A new study suggests even low-risk patients who underwent transcatheter aortic valve replacement (TAVR) may face an increased risk of death from inflammation developing in the heart’s inner lining, highlighting the importance of routine monitoring following the procedures.

The rate of prosthetic valve endocarditis resulting in patient mortality nearly doubled after the first year of implantation, according to the findings of a recent TAVR mortality study presented at the virtual meeting of the Society for Cardiovascular Angiography and Interventions (SCAI) on April 30.

TAVR is a type of heart procedure which allows the surgeon to replace the heart valve by threading it through an artery in the leg instead of via open chest surgery. It places the valve over the damaged aortic valve in a less invasive procedure.

Initially, TAVR was approved for use only among high risk patients who were frail or couldn’t undergo open heart surgery because the surgery carried such high risks. The durability of the heart valves was also untested for use in younger patients, who need implants designed to last 30 years or more, not just 10. However, the occurrence of infections such as Staphylococcus aureus developing around the heart following TAVR procedures has raised concerns.

Researchers from MedStar Washington Hospital Center in Washington, D.C. performed an analysis of 396 low-risk TAVR patients to determine the rate of prosthetic valve endocarditis (PVE), which is the development of an infection around the heart valve. PVE can cause a variety of complications including valve leaks, heart blocks, and abscesses, which can result in serious patient injury or death.

Of the 396 low-risk patients who underwent TAVR procedures, the incidence of PVE was 1.5% within one year. The rate of occurrence after one year nearly doubled to 2.8%. Researchers noted the survival rates among those with early endocarditis onsets was 100%, while those with late onsets had only a 67% survival rate.

Researchers identified 11 patients with PVE, in which three required surgical aortic valve reintervention, while six patients diagnosed with valve endocarditis suffered embolic strokes, two of whom died after antibiotic treatment alone.

The study indicates that low-risk TAVR patients are not immune to endocarditis, but researchers caution that these findings are no reason to favor a surgical or transcatheter valve over another during valve replacement.

While the study’s findings have not been published in a peer-reviewed journal and are considered preliminary at this time, prior research has highlighted patient safety risks surrounding TAVR, specifically the increased risk of patient mortality following revision surgeries.

In June 2020, University of Washington Medical Center researchers reported patients who underwent a valve-in-valve (ViV) surgery to repair a previous, failed transcatheter aortic valve replacement (TAVR) had lower survival rates and were more likely to need another surgery depending on certain factors, such as the size of the valve.

According to the findings, patients were  more likely to have a failed valve and need surgical intervention if their surgical valves had a smaller internal diameter, they were older, had reduced left ventricular ejection fraction, chronic kidney disease, diabetes, or had surgeons who used a non-transfemoral access during surgery.