Document Type : New and original researches in the field of Microbiology.
Authors
1
Department of Interventional Cardiology, College of Medicine, University of Kufa, Al-Najaf Al-Ashraf, Iraq.
2
Department of Interventional Cardiology, College of Medicine, University of Kufa, Al-Najaf Al-Ashraf, Iraq
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive and effective alternative for treating severe aortic stenosis, particularly in high-risk surgical patients. However, infective endocarditis following TAVI (PTIE) represents a rare but serious complication with significant morbidity and mortality, compounded by diagnostic delays and atypical clinical presentations. Objectives: This retrospective cross-sectional study aimed to investigate the incidence, clinical features, microbiological profile, diagnostic challenges, and short-term outcomes of PTIE, as well as to identify predictors of poor prognosis. Methods: Data were collected from 599 patients who underwent TAVI between February 2021 and January 2025 at a specialised cardiovascular centre. Patients diagnosed with PTIE according to the modified Duke Criteria were analysed. Demographics, comorbidities, procedural details, microbiological findings, imaging results, and clinical outcomes were recorded. Statistical analyses included Chi-square tests, t-tests, and logistic regression to identify independent predictors of in-hospital mortality. Results: Out of 599 patients, 27 (4.5%) developed PTIE. The median time from TAVI to infection onset was 64 days. The most common pathogens were Staphylococcus aureus (37%), Enterococcus faecalis (26%), and Streptococcus species (15%). Culture-negative cases accounted for 22%. Echocardiographic findings included prosthetic valve vegetations (59%), paravalvular abscesses (15%), and valve dehiscence (7%).Short-term outcomes included in-hospital mortality (25.9%), 30-day readmission (37%), and surgical intervention in 11.1%. Independent predictors of in-hospital mortality included S. aureus infection (OR = 3.5, p = 0.01), paravalvular abscess (OR = 4.2, p = 0.01), and diagnostic delay >7 days (OR = 5.1, p = 0.002). Conclusion: Although infrequent, PTIE carries a high risk of mortality and diagnostic difficulty. Early identification of clinical warning signs, especially in high-risk patients such as those with permanent pacemakers, chronic kidney disease, and prolonged ICU stays, is crucial. Improved imaging techniques and routine surveillance may reduce delays in diagnosis and enhance patient outcomes.
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