Infective Endocarditis After Transcatheter Aortic Valve Implantation. Issue 18 (5th May 2015)

• Record Type: Journal Article
• Authors: Amat-Santos, Ignacio J.; Messika-Zeitoun, David; Eltchaninoff, Helene; Kapadia, Samir; Lerakis, Stamatios; Cheema, Asim N.; Gutiérrez-Ibanes, Enrique; Munoz-Garcia, Antonio J.; Pan, Manuel; Webb, John G.; Herrmann, Howard C.; Kodali, Susheel; Nombela-Franco, Luis; Tamburino, Corrado; Jilaihawi, Hasan; Masson, Jean-Bernard; de Brito, Fabio Sandoli; Ferreira, Maria Cristina; Lima, Valter Correa; Mangione, José Armando; Iung, Bernard; Vahanian, Alec; Durand, Eric; Tuzcu, E. Murat; Hayek, Salim S.; Angulo-Llanos, Rocio; Gómez-Doblas, Juan J.; Castillo, Juan Carlos; Dvir, Danny; Leon, Martin B.; Garcia, Eulogio; Cobiella, Javier; Vilacosta, Isidre; Barbanti, Marco; R. Makkar, Raj; Ribeiro, Henrique Barbosa; Urena, Marina; Dumont, Eric; Pibarot, Philippe; Lopez, Javier; Roman, Alberto San; Rodés-Cabau, Josep;
• Is Part Of: Circulation. Volume 131:Issue 18(2015)
• Publication Date: 2015-05-05
• Subjects: Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.114.014089
• Languages: English
• ISSNs: 0009-7322

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).</p> </sec> <sec> <title>Methods and Results—</title> <p>This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1–14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55–9.64; <italic>P</italic>=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37–7.14; <italic>P</italic>=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were <italic>coagulase-negative staphylococci</italic> (24%), followed by <italic>Staphylococcus aureus</italic> (21%) and <italic>enterococci</italic> (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (<italic>P</italic>=0.037) and septic shock (<italic>P</italic>=0.002) were associated with increased in-hospital mortality.</p> </sec> <sec> <title>Conclusions—</title> <p>The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. <italic>Staphylococci</italic> and <italic>enterococci</italic> were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.</p> </sec> </abstract>