Infective Endocarditis After Transcatheter Aortic Valve Implantation

• DOI: 10.1161/circulationaha.114.014089
• Publication Date: 2015-03-10T02:12:59Z
• Authors: Ignacio J. Amat-S...; David Messika-Zei...; Helene Eltchaninoff; Samir Kapadia; Stamatios Lerakis; Asim N. Cheema; Enrique Gutiérrez...; Antonio J. Munoz-...; Manuel Pan; John G. Webb; Howard C. Herrmann; Susheel Kodali; Luis Nombela-Franco; Corrado Tamburino; Hasan Jilaihawi; Jean-Bernard Masson; Fabio Sandoli de ...; Maria Cristina Fe...; Valter Correa Lima; José Armando Mang...; Bernard Iung; Alec Vahanian; Eric Durand; E. Murat Tuzcu; Salim S. Hayek; Rocio Angulo-Llanos; Juan J. Gómez-Doblas; Juan Carlos Castillo; Danny Dvir; Martin B. Leon; Eulogio Garcia; Javier Cobiella; Isidre Vilacosta; Marco Barbanti; Raj R. Makkar; Henrique Barbosa ...; Marina Urena; Eric Dumont; Philippe Pibarot; Javier Lopez; Alberto San Roman; Josep Rodés-Cabau
• Keywords: Aged, 80 and over; Heart Failure; Male; Prosthesis-Related Infections; Incidence; Aortic Valve Stenosis; Endocarditis, Bacterial; Kaplan-Meier Estimate; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Heart Valve Prosthesis; Intubation, Intratracheal; Equipment Contamination; Humans; Female; Hospital Mortality; Registries; Enterococcus; Gram-Positive Bacterial Infections; Aged; Proportional Hazards Models

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.