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Nov 26, 2019

Infections After Valve Replacements are Rare but Life-Threatening

Even with non-surgical procedures, valve replacements carry a small but serious risk of infection.

Even with minimally invasive treatment options for a narrowed heart valve, valve replacements still carry a small but serious risk of infection, based on a study published in the American Heart Association journal Circulation.

The study, which included data from multiple clinical trials and registries, compared risk of infection after different types of valve replacement. Specifically, it compared safety of surgical valve replacement, which has been around for decades, with a newer procedure called transcatheter aortic valve replacement (TAVR).

Both procedures are used to treat aortic stenosis, which occurs when the heart valve narrows and reduces blood flow to the heart. However, TAVR is minimally invasive and inserts the new valve using a tiny catheter tube, while surgery requires opening the chest to replace the faulty valve.

In many patients, TAVR has proven just as safe, if not more so, than traditional surgery. However, valve replacement still carries risk of infection regardless of which procedure is done, based on recent findings.

In total, the study included 8,530 patients who underwent valve replacement for severe aortic stenosis. Among participants, 85% underwent the minimally invasive procedure and 15% had traditional surgery.

After following participants for nearly three years post-procedure, 107 patients developed a serious infection called prosthetic valve endocarditis. The infection is a known complication of valve replacement and can occur within days, months or years after the procedure. It is a potentially fatal condition that can lead to heart failure and other serious complications.

As expected, patients who developed an infection had four times greater risk of death than those who did not. However, there was no difference in risk for infection among patients undergoing TAVR vs. surgery, confirming that neither is superior for the prevention of infection.

Authors also note that most cases of infection occurred between 31 days and one year after the procedure and patients with greatest risk of infection were those with kidney, lung and liver disease.

The take-home message, according to authors, is that no type of valve replacement offers clear protection against infection. Both surgery and TAVR carry some risk of serious infection. The good news, however, is that risk of infection from either procedure is very rare—affecting approximately 1% of participants in this study.

Authors also note that most participants in this study were at high risk of complications, since TAVR was relatively new when the studies were conducted. Now that TAVR has been expanded to lower-risk populations, experts encourage similar research to continue to track differences in safety and outcomes.

Questions for You to Consider

  • What is aortic stenosis and how does it progress over time?

  • Aortic stenosis occurs when the aortic valve does not open fully, which can obstruct normal blood flow and put extra stress on the heart. Aortic stenosis can start out mild, but worsen over time as the area of the aortic valve decreases lessening the amount of blood flowing from the heart. Patients with aortic stenosis should be continually monitored by a cardiologist to track the progression of this condition, and strenuous activity should be avoided in those with moderate to severe aortic stenosis.
  • What is TAVI?

  • Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure in which the faulty aortic valve is replaced with a prosthetic valve using a small tube that travels from an artery in the leg or chest to the heart. TAVI is less invasive than traditional open-heart surgery and often reserved for individuals at increased risk of complications from aortic valve surgery.

Infographic: TAVR


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