Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

Regueiro, Ander; Linke, Axel; Latib, Azeem; Ihlemann, Nikolaj; Ureña, Marina; Walther, Thomas; Hüsser, Oliver; Herrmann, Howard C.; Nombela‐Franco, Luis; Cheema, Asim N.; Breton, Hervé; Stortecky, Stefan; Kapadia, Samir; Bartorelli, Antonio L.; Sinning, Jan Malte; Amat‐Santos, Ignacio J.; Muñoz-García, Antonio J.; Lerakis, Stamatios; Gutiérrez‐Ibañes, Enrique; Abdel‐Wahab, Mohamed; Tchétché, Didier; Testa, Luca; Eltchaninoff, Hélène; Livi, Ugolino; Castillo, Juan Carlos; Jilaihawi, Hasan; Webb, John G.; Barbanti, Marco; Kodali, Susheel; Brito, Fábio Sândoli de; Ribeiro, Henrique Barbosa; Miceli, Antonio; Fiorina, Claudia; Dato, Guglielmo Mario Actis; Rosato, Francesco; Serra, Violeta; Masson, Jean Bernard; Wijeysundera, Harindra C.; Mangione, José Armando; Ferreira, Maria Cristina Duarte; Lima, Valter C.; Carvalho, Lucila; Abizaid, Alexandre; Mariño, Marcos Antonio Maynar; Esteves, Vinícius; Andrea, Júlio; Giannini, Francesco; Messika–Zeitoun, David; Himbert, Dominique; Kim, Won Keun; Pellegrini, Costanza; Auffret, Vincent; Nietlispach, Fabiàn; Pilgrim, Thomas; Durand, Éric; Lisko, John; Makkar, Raj; Lemos, Pedro A.; Leon, Martin B.; Puri, Rishi; Román, Alberto San; Vahanian, Alec; Søndergaard, Lars; Mangner, Norman; Rodés‐Cabau, Josep

doi:10.1001/jama.2016.12347

Cited by 279 publications

(347 citation statements)

References 32 publications

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“…Surgery could be performed in only 14.8% of patients (despite 81.2% having at least 1 indication for surgery, according to current guidelines) and was not associated with a reduced risk of in‐hospital death. This very low rate of valve surgery is likely secondary to the very high surgical risk of such patients, in addition to the potential technical difficulties of removing a stent frame adherent to the aorta 4. Similar trends were observed in smaller series 15, 16…”

Section: Treating Tavr Endocarditissupporting

confidence: 59%

“…Data about echocardiography in TAVR‐IE, however, are still scarce and are based on registries or retrospective studies, which explains why the value of the Duke criteria7 in this population is unknown. The most recent and largest studies on TAVR‐IE gave few new information about the value of echocardiography in these patients 3, 4…”

Section: Diagnosing Tavr Endocarditismentioning

confidence: 99%

“…Unfortunately, these recommendations cannot be applied in all patients with TAVR‐IE because contraindications to surgery frequently exist in this high‐risk population. In the largest registry, reporting 250 cases,4 TAVR‐IE was associated with an in‐hospital mortality rate of 36% and a 2‐year mortality rate of 66.7%. Surgery could be performed in only 14.8% of patients (despite 81.2% having at least 1 indication for surgery, according to current guidelines) and was not associated with a reduced risk of in‐hospital death.…”

Section: Treating Tavr Endocarditismentioning

confidence: 99%

“…Infective endocarditis (IE) is a recently described complication of TAVR that is difficult to diagnosis and has a dismal prognosis; TAVR‐IE deserves prompt diagnosis and treatment 2, 3, 4. However, relatively few data exist concerning TAVR‐IE and the best way to manage these patients, particularly concerning the benefit of early surgery.…”

Section: Introductionmentioning

confidence: 99%

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Infective Endocarditis After Transcatheter Aortic Valve Replacement: The Worst That Can Happen

Habib

2018

JAHA

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Section: Treating Tavr Endocarditissupporting

confidence: 59%

Section: Diagnosing Tavr Endocarditismentioning

confidence: 99%

Section: Treating Tavr Endocarditismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infective Endocarditis After Transcatheter Aortic Valve Replacement: The Worst That Can Happen

Habib

2018

JAHA

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“…In a large study by Regueiro et al54 that included 20 006 patients with TAVR, 250 had definite IE (incidence, 1.1%; 95% CI, 1.1%–1.4% per patient‐year) at a median interval of 5.3 months (interquartile range, 1.5–13.4 months) after the procedure, and IE was early in 178 patients (71.2%). In‐hospital mortality and surgical conversion rates were 36% and 15%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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BackgroundInfective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data.Methods and ResultsPubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient‐years of follow‐up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient‐year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0–30.4) months (range, 1.0–72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001).ConclusionsThe incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.

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Management Considerations in Infective Endocarditis

Wang

Gaca

Chu

2018

JAMA

301

209

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ndocarditis is an infection of the cardiac endothelium and can present as either acute or subacute disease. Acute infective endocarditis advances rapidly, presenting with a sudden onset of high fever, rigors, sepsis, and systemic complications. This presentation alone is indistinguishable from other causes of sepsis, but when there is also a new-onset heart murmur, a diagnosis of acute infective endocarditis should be considered. In contrast, subacute infective endocarditis can be difficult to diagnose. Patients develop nonspecific symptoms such as fatigue, dyspnea, or weight loss over several weeks to months. Fever may or may not be present. Although endocarditis is commonly associated with a heart murmur due to valve regurgitation, new murmurs are present in less than half of cases (Table 1). 1,2 Janeway lesions or Osler nodes are classic diagnostic findings (Figure 1), but they are present in fewer than 5% of cases. Imaging can reveal embolic phenomena such as pulmonary and splenic emboli (Figure 2). Infective endocarditis should be suspected when patients present with either an acute or subacute illness when infective endocarditis risk factors are present (Box 1). In general, Staphylococcus aureus infection causes acute, aggressive infections, and the more indolent pathogens, viridans group streptococci or coagulase-negative staphylococci, cause subacute infective endocarditis. MethodsWe conducted a literature search of the PubMed database from January 2008 through March 2018. The selection, including clinical trials, observational studies, review articles, and society guidelines, was limited to studies published in English. We reviewed the reference articles that were cited in the guidelines IMPORTANCE Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings.OBSERVATIONS Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries. As medical interventions are increasingly performed on older patients, the disease incidence from cardiac implanted electronic devices is also increasing. In addition, younger patients involved with intravenous drug use has increased in the past decade and with it the proportion of US hospitalization has increased to more than 10%. These epidemiological factors have led to Staphylococcus aureus being the most common cause in high-income countries, accounting for up to 40% of cases. The mainstays of diagnosis are still echocardiography and blood cultures. Adjunctive imaging such as cardiac computed tomographic and nuclear imaging can improve the sensitivity for diagnosis when echocardiography is not conclusive. Serological studies, histopathology, and polymerase chain reaction assays have distinct ro...

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Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

Cited by 279 publications

References 32 publications

Infective Endocarditis After Transcatheter Aortic Valve Replacement: The Worst That Can Happen

Infective Endocarditis After Transcatheter Aortic Valve Replacement: The Worst That Can Happen

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Management Considerations in Infective Endocarditis

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