No abstract

Background-We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and Results-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; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37-7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data).The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (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 (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality. Conclusions-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. Staphylococci and enterococci 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. Clinical Perspective on p 1574Transcatheter aortic valve implantation (TAVI) represents a paradigm shift in the treatment of aortic stenosis in patients considered at high or prohibitive surgical risk. 5 The reported rates of early IE after TAVI have varied from 0.1% to 3.03%, [6][7][8] with no differences compared with surgical aortic valve replacement, as shown in the prospective randomized Placement of Aortic Transcatheter Valves (PARTNER) trial. 6 However, data on the clinical characteristics, causes, treatment, and clinical outcomes of IE after TAVI are scarce and limited to case reports and small series, which indeed may suffer from publication bias.9 Such information is crucial to improve both the diagnosis and management of this entity in the context of TAVI. The particular features of TAVI candidates and the specific design of transcatheter valve prostheses, including a much higher amount of metal (stent frame) around the valve leaflets compared with surgical valves, may indeed alter the outcome and management of IE. The objectives of this multicenter registry were thus to evaluate the incidence, predictors, and cl...