title: Prosthetic valve endocarditis after transcatheter aortic valve implantation: the incidence in a single-centre cohort and reflections on clinical, echocardiographic and prognostic features.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has recently developed into an accepted alternative to conventional surgery in high-risk patients. According to current data, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely.
  
  
  RESULTS
  We followed the first 180 consecutive patients who underwent TAVI at our institution to assess safety and efficacy of the procedure. During follow-up (median, 319 days), PVE was seen more frequently than expected. By applying modified Duke criteria five cases could be confirmed (four early-onset and one late-onset PVE, four cases with "definite diagnosis" and one with "possible diagnosis") representing an estimated PVE incidence of 3.4% at one year. Two patients died subsequently. Clinical summaries of all cases are reported and compared to previously published case reports.
  
  
  CONCLUSIONS
  According to our hypothesis, PVE might be particularly difficult to diagnose after TAVI, whereas TAVI-specific elderly patients might be exceptionally vulnerable. There exists little experience of TEE interpretation in post-TAVI endocarditis which should possess unique characteristics regarding, e.g., valve dehiscence or abscess formation. Therefore, echocardiography as a diagnostic tool often remains initially inconclusive. Because of incongruence between prosthetic device and calcified native aortic valve, some degree of paravalvular leak is common after TAVI. These paravalvular leaks as a nidus for infection, advanced age and abundant comorbidities might predispose TAVI patients for infective endocarditis.
authors.affiliation: Department of Cardiology, Georg August University of Goettingen, Goettingen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Puls
authors.forename: Helmut
authors.initials: H
authors.lastname: Eiffert
authors.forename: Mark
authors.initials: M
authors.lastname: Hünlich
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schöndube
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Ralf
authors.initials: R
authors.lastname: Seipelt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
mesh_terms: D000369:Aged, 80 and over; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome