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TAVI Endocarditis Challenges — EECC MCQ

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ModerateValvular Heart DiseaseTAVI Endocarditis ChallengesEECC

A 70-year-old man 3 years after TAVI develops fever and new aortic regurgitation. Blood cultures grow Enterococcus faecalis. TOE shows a vegetation on the TAVI prosthesis. How does TAVI endocarditis compare with surgical prosthetic valve endocarditis?

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Correct answer: E — TAVI endocarditis has a reported incidence of 0.5-3% per year and carries a high mortality (30-40%); unique challenges include: larger prosthesis frames complicate imaging, percutaneous extraction is not feasible, and redo surgery after TAVI is technically demanding

TAVI endocarditis (IE after TAVI) is an emerging clinical challenge: (1) incidence: 0.5-3% per year (comparable to surgical PVE); (2) mortality: 30-40% (similar or higher than surgical PVE); (3) organisms: enterococci and staphylococci are most common (reflecting the elderly population with healthcare exposure); (4) unique challenges: (a) imaging — large metal frame causes artefact on echo and CT; FDG-PET may be particularly valuable; (b) surgery — redo surgery after TAVI is technically challenging (TAVI frame embedded in native calcified annulus, limited access); (c) no percutaneous 'extraction' option (unlike CIED leads); (d) antibiotic prophylaxis recommendations apply equally to TAVI as to surgical prosthetic valves. The 2023 ESC IE and 2025 VHD Guidelines recommend the same diagnostic and treatment approach as for surgical PVE.

Reference: ESC (2023): IE Guidelines; ESC/EACTS (2025): VHD Guidelines