Abramowitz, Yigal

Amit, Sharon

Assa, Eyal Ben–

Banai, Shmuel

Finkelstein, Ariel

Keren, Gad

Leshem–Rubinow, Eran

Steinvil, Arie

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FEVER FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: PREVALENCE, PATTERN AND RATE ATTRIBUTED TO AN INFECTIOUS ORIGIN 

Valvular Heart Disease
E1955
JACC March 12, 2013
Volume 61, Issue 10
fever following TranscaTheTer aorTic valve implanTaTion: prevalence, paTTern and raTe 
aTTriBuTed To an infecTious origin
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: TAVR I: Predictors of TAVR Outcomes Including LVEF, Contractile Reserve, BNP, Pulmonary HTN, CA 125, and Fever
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1156M-89
Authors: Eran Leshem-Rubinow, Sharon Amit, Arie Steinvil, Eyal Ben- Assa, Yigal Abramowitz, Gad Keren, Shmuel Banai, Ariel Finkelstein, Department 
of Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel, Infectious Disease Unit, Tel-Aviv Medical Center; Sackler faculty of medicine, Tel-Aviv University, 
Tel Aviv, Israel
Background: The occurrence of fever following transcatheter aortic valve implantation (TAVI) is common and may result in extensive workup, 
treatment with broad-spectrum antibiotics and prolonged hospitalization. We aimed to assess the prevalence and nature of fever following TAVI, and 
analyze whether cases of fever were attributed to infection.
methods: An observational retrospective study of the first 141 consecutive patients undergoing TAVI in a 1,200-bed university hospital. All patients 
received peri-procedural antibiotic prophylaxis with a first or second generation cephalosporin (or vancomycin upon penicillin allergy). Data 
regarding fever was extracted from medical and nursing records. All microbiologic samples were reviewed and analyzed.
results: Fever above 37.8c occurred in 32 patients (22.7%) in the first 96 hours following TAVI. A single measure above 37.8c was reported for 19 
(59.4%) patients, while 13 (40.6%) patients had at least two measures > 37.8c. Empiric broad-spectrum antibiotic was initiated in 75% of febrile 
patients, more commonly when fever was high and in all cases when prolonged. Bacteremia was found in 2 febrile patients, both pathogens isolated 
not covered by the standard prophylactic regimen (Enterococcus Fecalis; ESBL-producing Klebsiella Pneumoniae). Fever was not associated with 
increased 30 days mortality, yet correlated with several post-procedural complications and prolonged hospitalization.
conclusions: Fever following TAVI is common, yet rarely associates with microbiologically-proven infection and may actually represent an 
inflammatory response following valve deployment. Differing antibiotic treatment in the face of a single peri-procedural febrile spike may be 
considered, yet a protracted course of fever mandates the initiation of broad-spectrum antibiotics.
*First and second authors should be considered as equal contributors.


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FEVER FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: PREVALENCE, PATTERN AND RATE ATTRIBUTED TO AN INFECTIOUS ORIGIN

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