Transcatheter aortic valve implantation (TAVI) prostheses

Background: Transcatheter aortic valve implantation (TAVI) is a percutaneous catheter-based treatment of aortic stenosis as an alternative to open heart valve surgery. In cases of TAVI endocarditis, the treatment possibilities may be limited as surgical removal of the infected valve may be associated with a high risk in elderly, comorbid or frail patients. The propensity of bacteria to form a biofilm on foreign material is assumed to be of importance part of the disease process in TAVI endocarditis, but no studies on biofilm formation on TAVI valves have been conducted. We hypothesize that Methods: TAVI valves (pieces including part of the metal frame, approximately 1 cm wide) were exposed to either species Results: Exposure for 15 min established attachment to all of valve pieces. SEM findings were consistent with biofilm formation and suggested lower amounts of bacteria on the metal compared to the tissue part of the TAVI valves. The number of bacteria attached to the TAVI valves increased until 24 h of incubation from less than 10^1 to a level of approximately 10^9 CFU/g. The bacteria became more tolerant to antibiotics on the TAVI valves over time, with the bactericidal effect against 24-h old biofilm being significantly less effective than against 0-h old biofilm depending on antibiotic. Conclusions: The results indicate that bacteria can adhere to metal and tissue parts of the TAVI valves within minutes after an exposure which is comparable to transient bacteremia