Servoz C, Wintzer-Wehekind J, Monségu J
Institut cardiovasculaire, Groupe Hospitalier Mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
Institut cardiovasculaire, Groupe Hospitalier Mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
Ann Cardiol Angeiol (Paris). 2020 Dec;69(6):400-403. doi: 10.1016/j.ancard.2020.09.036. Epub 2020 Oct 12.
Since trans-catheter valve implantation (TAVI) has emerged for severe symptomatic aortic stenosis treatment, infective endocarditis (IE) appears as a rare but severe complication. Like surgical aortic valve remplacement infective endocarditis (SAVR-IE), TAVI-IE has a noxious impact on morbidity and mortality. Compared to SAVR-IE, TAVI-IE present some similarities as well as differences. Most TAVI-IE occurred during the first year and enterococcus is the more common pathogen. A multimodality imaging approach including echocardiography, multislice computed tomography (CT) and positron emission tomography-CT with blood culture is necessary for the diagnosis. In this high-risk population, the vast majority of TAVI-IE patients are treated with antibiotic therapy alone. Consequently to the expanded indication, the increasing number of TAVI-IE will appear more frequently. If initially only few clinical cases of IE were reported, sparse observational multicenter registries have now been published. Relevant differences were noted on these registries, but some recent publications have provided new informations on IE. The present review reports incidence, symptoms, microbiological profil, risk factors and clinicals outcomes of TAVI-IE. Eventually, we describe the management and the treatment of IE in the context of TAVI.
自从经导管瓣膜植入术(TAVI)出现用于治疗严重症状性主动脉瓣狭窄以来,感染性心内膜炎(IE)已成为一种罕见但严重的并发症。与外科主动脉瓣置换术后感染性心内膜炎(SAVR-IE)一样,TAVI-IE对发病率和死亡率有不良影响。与SAVR-IE相比,TAVI-IE既有一些相似之处,也有不同之处。大多数TAVI-IE发生在第一年,肠球菌是较常见的病原体。诊断需要采用包括超声心动图、多层计算机断层扫描(CT)和正电子发射断层扫描-CT以及血培养在内的多模态成像方法。在这个高危人群中,绝大多数TAVI-IE患者仅接受抗生素治疗。由于适应证的扩大,TAVI-IE的病例数将更频繁地出现。如果最初仅报道了少数IE临床病例,现在已经发表了一些稀疏的观察性多中心登记研究。在这些登记研究中发现了相关差异,但最近的一些出版物提供了关于IE的新信息。本综述报告了TAVI-IE的发病率、症状、微生物学特征、危险因素和临床结局。最后,我们描述了在TAVI背景下IE的管理和治疗。