Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA.
Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, TX, USA.
Curr Cardiol Rep. 2024 Jul;26(7):767-775. doi: 10.1007/s11886-024-02076-9. Epub 2024 May 28.
This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology.
Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
本综述探讨了经导管主动脉瓣置换术相关感染性心内膜炎(TAVR-IE)和经导管二尖瓣瓣环成形术相关感染性心内膜炎(TEER-IE)的流行病学、临床特征和诊断,重点关注多模态成像方法。它涉及到 TAVR 和 TEER 的发病率不断上升,强调需要了解长期并发症和临床后果,尽管瓣膜技术不断进步,但这仍然是一个重大挑战。
研究报告 TAVR-IE 和 TEER-IE 的发病率存在差异,这受到不同患者风险特征和手术因素的影响。年龄较小、男性和某些合并症是与患者相关的风险因素。手术相关因素包括介入部位、瓣膜类型和技术方面。微生物方面,金黄色葡萄球菌、草绿色链球菌和肠球菌是常见的病原体。由于超声心动图的局限性,TAVR-IE 和 TEER-IE 的诊断需要采用多模态成像方法。血液培养和影像学检查有助于识别,荧光原位杂交技术显示出良好的前景。治疗包括抗生素的药物治疗,必要时进行手术干预。管理方法需要多学科的“心内膜炎团队”。本综述强调需要继续研究,以完善风险预测、提高诊断准确性,并优化 TAVR-IE 的管理策略,考虑到经导管介入治疗的不断发展。