Temporary Trends in Fever Following Transcatheter Aortic Valve Implantation

Objectives: Fever following transcatheter aortic valve implantation (TAVI) is a common phenomenon, attributed mostly to inflammatory response which may impact outcome. Systemic inflammatory response may be triggered by multiple factors, most associated with the TAVI procedure itself. However, there is no data regarding the incidence of fever following TAVI in contemporary era with newer generation devices. Our primary objective was to measure temporal trends in fever incidence and features following TAVI.

Methods: We analyzed a retrospective cohort of 802 consecutive patients who underwent TAVI at our institution between 11.2008 to 2.2018. We identified and characterized all patients who developed fever (> 38.0ºC from all cause) within the first 72 hours following the procedure and analyzed the incidence and characteristics of fever according to 3 time periods: 2008-2014, 2014-2016 and 2016-2018.

Results: Following TAVI, 190 (23.7%) patients had fever (mean age 82.3±5.2 years, 64.2% female). An infectious etiology was evident in only 32.1% of fever cases. The frequency of fever decreased gradually and significantly across time periods (32.8%, 23.6%, 14.5% respectively, p<0.001). In a multivariate regression analysis 1^st generation CoreValve (HR 1.91; CI 95% 1.2-3.04, p=0.006 ) was found to be associated we the higher incidence of fever in addition to female gender, vascular complications, transfemoral access, and low GFR.

Conclusions: In our experience, fever post TAVI decreased significantly throughout the last decade. The higher rate of fever in the early years of TAVI was most probably attributed to 1^st generation devices, vascular complications and low GFR. Lower incidence of post TAVI fever may allow faster discharge.