Infective endocarditis after transcatheter aortic valve implantation: a nationwide study

Abstract

Aims Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study. Methods and results Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0–1.8%) the first year and 0.8% (0.6–1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49–68%), and 5-year survival was 29% (17–41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality. Conclusion The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients. Clinical Trial Registration NCT03768180 (http://clinicaltrials.gov/).

Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

“…A temporary pacing lead may also be an entry point for bacteria into the bloodstream. Staphylococcus aureus was the cause of PVE in 25% of the patients, which was comparable with the findings of other studies [17,23].…”

“…We were, however, unable to test for independent risk factors, due to the low number of patients with PVE. On the other hand, renal impairment was previously described as a risk factor for PVE post-TAVR [9,17]. Other identified risk factors include older age, male sex, diabetes, COPD, vascular complications and residual aortic regurgitation post-TAVR [9].…”

“…When comparing our results with those of previous studies, especially other nationwide registries, we observed lower incidences (cumulative and incidence rate). In the studies of Bjursten et al (Sweden) [17] and Butt et al (Denmark) [13], post-TAVR patients were screened in a similar way to the procedure in our study. Both reported higher cumulative first-year incidences (1.4% [17] and 2.3% [13] vs 0.23% in our study), while incidence rates were more comparable (0.16 vs 0.13 events per 1000 person-years [13]).…”

“…PVE is a rare complication, with reported first-year incidences of 0.3-1.8% after surgical aortic valve implantation (SAVR) [2,6,[10][11][12][13], associated with high morbidity and mortality rates [10,13]. For TAVR these incidences vary from 0.57 to 3.1%, based on small studies and a few larger nationwide registries [9,[13][14][15][16][17]. With the shift of TAVR indication towards lower-risk patients, it is of particularly interest how the incidence and outcome of PVE post-TAVR differs from post-SAVR.…”

Valve‐in‐valve transcatheter aortic valve replacement for degenerative prosthetic valve endocarditis

“…1 Increasingly, despite these recommendations transcatheter aortic valve replacement (TAVR) has gained more popularity for valve-in-valve treatment of valvular complications of infective endocarditis. 2…”