Abstract 12109: Infective Endocarditis Post-Transcatheter Edge-to-Edge Mitral Valve Repair: A Systematic Review

Background: Infective Endocarditis (IE) post-MitraClip procedure has not been well recognized, with very limited reports published to date.

Objective: We aim to systematically evaluate the clinical characteristics, management, outcomes, and prognosis among IE patients after Mitral valve repair with the MitraClip device.

Methods: We conducted a systematic literature search in PubMed, Embase, and Scopus from inception till 10th March 2023 by using predefined MESH terms and "AND" and "OR." The following search terms were used: “Infective Endocarditis” AND “Transcatheter mitral valve repair”.

Results: A total of 26 publications describing 29 cases of IE following percutaneous edge-to-edge mitral valve repair were identified. The mean age of the patients was 72.62 ± 12.76 years, of which 62.96% were male. The etiology of MR was mostly functional/secondary in 54.55% of cases, while the mean number of implanted clips was 1.65 ± 0.68 (Mode = 1), and the most common location for MitraClip® implantation was the A2-P2 segment. The mean duration from MitraClip® intervention to readmission with IE was 44.44 ± 57.11 weeks. Echocardiography findings showed severe MR in 70.83% of patients. Staphylococcus aureus was the most common infectious organism involved in 56% of cases. Surgical mitral valve replacement with a bioprosthesis was performed in 55.17% of the patients, and 34.48% were managed medically. The most common antibiotic regimen was vancomycin, in addition to rifampicin and gentamycin. Mortality was higher in the medically managed patients as compared to the ones that underwent surgical MVR (40% vs. 37.5%).

Conclusion: IE post-TEER of the mitral valve is a rare complication but is associated with a higher mortality rate. Aggressive antibiotic medication and proper prophylaxis during index procedures can be beneficial.