Interventions for valvular disease and heart failure

A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation

EuroIntervention 2021;16:1135-1140. DOI: 10.4244/EIJ-D-19-00993

Anna Conen
Anna Conen1, MD, MSc; Stefan Stortecky2, MD; Philippe Moreillon3, MD; Margaret M. Hannan4, MD; Fabian C. Franzeck5, MD; Raban Jeger6, MD; Andreas F. Widmer5, MD, MSc
1. Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland; 2. Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; 3. Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland; 4. Department of Clinical Microbiology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland; 5. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland; 6. Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a new disease entity. The rate of IE after TAVI is similar to that after surgical aortic valve replacement (SAVR), but mortality and prevalence of Enterococcus spp. as causing pathogens are significantly higher. Guidelines on infection prevention measures before TAVI procedures are currently lacking. We performed a structured review of the available data to provide interim recommendations based on guidelines to prevent infections issued by the World Health Organization as well as guidelines by professional societies from Europe and the USA. Such interim recommendations based on expert opinions are probably justified until large randomised trials provide strong evidence for infection control in TAVI, because IE after TAVI is often related to the TAVI procedure itself and the associated mortality rate is high. Antibiotic prophylaxis should be adapted from an intravenous cephalosporin to, e.g., amoxicillin/clavulanic acid, to cover enterococci. In addition, infection control should follow operating room standards as far as is reasonable, even if the evidence for this recommendation is very low. These recommendations are endorsed by the International Society for Cardiovascular Infectious Diseases (ISCVID).

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Interventions for valvular diseaseTAVI
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