Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement . (11th December 2021)

• Record Type: Journal Article
• Authors: Panagides, Vassili; del Val, David; Abdel-Wahab, Mohamed; Mangner, Norman; Durand, Eric; Ihlemann, Nikolaj; Urena, Marina; Pellegrini, Costanza; Giannini, Francesco; Gasior, Tomasz; Wojakowski, Wojtek; Landt, Martin; Auffret, Vincent; Sinning, Jan Malte; Cheema, Asim N; Nombela-Franco, Luis; Chamandi, Chekrallah; Campelo-Parada, Francisco; Munoz-Garcia, Erika; Herrmann, Howard C; Testa, Luca; Kim, Won Keun; Castillo, Juan Carlos; Alperi, Alberto; Tchetche, Didier; Bartorelli, Antonio L; Kapadia, Samir; Stortecky, Stefan; Amat-Santos, Ignacio; Wijeysundera, Harindra C; Lisko, John; Gutiérrez-Ibanes, Enrique; Serra, Vicenç; Salido, Luisa; Alkhodair, Abdullah; Livi, Ugolino; Chakravarty, Tarun; Lerakis, Stamatios; Vilalta, Victoria; Regueiro, Ander; Romaguera, Rafael; Kappert, Utz; Barbanti, Marco; Masson, Jean Bernard; Maes, Frédéric; Fiorina, Claudia; Miceli, Antonio; Kodali, Susheel; Ribeiro, Henrique B; Mangione, Jose Armando; Sandoli de Brito, Fabio; Actis Dato, Guglielmo Mario; Rosato, Francesco; Ferreira, Maria Cristina; Correia de Lima, Valter; Colafranceschi, Alexandre Siciliano; Abizaid, Alexandre; Marino, Marcos Antonio; Esteves, Vinicius; Andrea, Julio; Godinho, Roger R; Alfonso, Fernando; Eltchaninoff, Helene; Søndergaard, Lars; Himbert, Dominique; Husser, Oliver; Latib, Azeem; Le Breton, Hervé; Servoz, Clement; Pascual, Isaac; Siddiqui, Saif; Olivares, Paolo; Hernandez-Antolin, Rosana; Webb, John G; Sponga, Sandro; Makkar, Raj; Kini, Annapoorna S; Boukhris, Marouane; Gervais, Philippe; Linke, Axel; Crusius, Lisa; Holzhey, David; Rodés-Cabau, Josep;
• Is Part Of: Clinical infectious diseases. Volume 75:Number 4(2022)
• Page Start: 638
• Page End: 646
• Publication Date: 2021-12-11
• Subjects: heart surgery -- infective endocarditis -- TAVI -- TAVR; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab1004
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. Methods: This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53–421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula. Results: A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj ], 2.08; 95% confidence interval [CI]: 1.27–3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57–4.69; P < .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, P < .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization ( p adj < 0.05 for all). Conclusions: PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes. Abstract : Perivalvular extension was diagnosed in 18.1% of patients with infective endocarditis after transcatheter aortic valve replacement. Chronic kidney disease and coagulase-negative streptococci were risk factors of this serious complication. Surgery was associated with better outcomes.