Post-procedural Fever After Transcatheter Aortic Valve Implantation (TAVI). A Multi-centric Study

Overview

Journal Infez Med

Specialty Infectious Diseases

Date 2025 Mar 12

PMID 40071261

Authors

Valentina Scheggi

Yohann Bohbot

Jasim Hasan

Pierre Vanhaecke

Stefano Del Pace

Carlo Fumagalli

Francesco Meucci

Giulia Nardi

Francesca Di Muro

Silvia Menale

Elena Pisani

Veronica Vitiello

Valeria Setti

Nicola Zoppetti

Renato Valenti

Alfredo Cerillo

Pier Luigi Stefano

Carlo Di Mario

Dan Rusinaru

Anfani Mirode

Christophe Tribouilloy

Niccolo Marchionni

Affiliations

Soon will be listed here.

Abstract

Background: Fever following transcatheter aortic valve implantation (TAVI) poses a clinical challenge, necessitating a comprehensive diagnostic approach to discern between infectious and non-infectious origins. Despite its minimally invasive nature, TAVI disrupts protective anatomical barriers, leading to an increased risk of infection, as well as to aseptic inflammatory responses. Standardized strategies for the management of these patients are lacking.

Methods: We retrospectively analyzed 1074 consecutive patients. Data retrieved from electronic hospital charts included demographics, comorbidities, NYHA functional class, Multidimensional Prognostic Index (MPI), EUROSCORE II and STS risk score, pre- and post-procedural echocardiographic data, and procedural details. Fever was defined as temperature >37.5°C.

Results: Overall, 391 patients (36.4%) experienced at least one episode of fever, in all cases ensuing within the first 2 days after the procedure. Fever lasted only one day (ODF) in most patients (86%). Antibiotic prophylaxis varied, with cefazolin showing the highest efficacy. Management of post-TAVI fever was heterogeneous. Twenty-five percent of febrile patients received an empiric antibiotic therapy, although a presumed site of infection was identified in only 17% of them and just 19 patients (4.9%) had positive blood cultures. Of the 19 patients with positive cultures, 11 had a Gram+ and 8 a Gram-infection. Fever duration, invasive accesses, and clinical suspicion of infection influenced antibiotic initiation. Fever lasting more than one day (MODF) was associated with new-onset atrial fibrillation and prolonged in-hospital stay. Positive blood cultures were linked to higher mortality, especially with Gram-bacteremia. However, patients with short-term fever had a similar mortality to those without fever, highlighting the benign nature of self-limited fever.

Conclusions: Fever is a common complication after TAVI. A watchful waiting strategy is advisable in stable patients without evidence of infection and self-limited episodes of fever, while selected patients may benefit from an aggressive approach.

References

Orvin K, Kornowski R, Bishara J, Bental T, Levi A, Noam N . The frequency and prognostic impact of fever following transcatheter aortic valve implantation. Cardiology. 2014; 127(3):203-10. DOI: 10.1159/000356940. View

OBrien S, Shahian D, Filardo G, Ferraris V, Haan C, Rich J . The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery. Ann Thorac Surg. 2009; 88(1 Suppl):S23-42. DOI: 10.1016/j.athoracsur.2009.05.056. View

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36):2739-2791. DOI: 10.1093/eurheartj/ehx391. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Sedaghat A, Sinning J, Vasa-Nicotera M, Ghanem A, Hammerstingl C, Grube E . The revised EuroSCORE II for the prediction of mortality in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol. 2013; 102(11):821-9. DOI: 10.1007/s00392-013-0596-8. View

Leshem-Rubinow E, Amit S, Steinvil A, Ben-Assa E, Abramowitz Y, Keren G . Frequency, pattern, and cause of fever following transfemoral transcatheter aortic valve implantation. Am J Cardiol. 2014; 113(6):1001-5. DOI: 10.1016/j.amjcard.2013.11.063. View

Makkar R, Fontana G, Jilaihawi H, Kapadia S, Pichard A, Douglas P . Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012; 366(18):1696-704. DOI: 10.1056/NEJMoa1202277. View

Scheggi V, Del Pace S, Fumagalli C, Meucci F, Nardi G, Di Muro F . Post-procedural fever after transcatheter aortic valve implantation: a retrospective single-centre study. J Hosp Infect. 2023; 144:151-153. DOI: 10.1016/j.jhin.2023.10.024. View

Gorla R, Erbel R, Eagle K, Bossone E . Systemic inflammatory response syndromes in the era of interventional cardiology. Vascul Pharmacol. 2018; . DOI: 10.1016/j.vph.2018.04.003. View

10.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J . 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021; 43(7):561-632. DOI: 10.1093/eurheartj/ehab395. View

11.

Baron S, Arnold S, Wang K, Magnuson E, Chinnakondepali K, Makkar R . Health Status Benefits of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER 2 Randomized Clinical Trial. JAMA Cardiol. 2017; 2(8):837-845. PMC: 5710586. DOI: 10.1001/jamacardio.2017.2039. View

12.

Sinning J, Scheer A, Adenauer V, Ghanem A, Hammerstingl C, Schueler R . Systemic inflammatory response syndrome predicts increased mortality in patients after transcatheter aortic valve implantation. Eur Heart J. 2012; 33(12):1459-68. DOI: 10.1093/eurheartj/ehs002. View

13.

Pilotto A, Custodero C, Maggi S, Polidori M, Veronese N, Ferrucci L . A multidimensional approach to frailty in older people. Ageing Res Rev. 2020; 60:101047. PMC: 7461697. DOI: 10.1016/j.arr.2020.101047. View