Infective endocarditis after transcatheter aortic valve implantation : results from a large multicenter registry

Authors: Amat Santos, Ignacio J.; Messika-Zeitoun, David; Eltchaninoff, Hélène; Kapadia, Samir R.; Lerakis, Stamatios A.; Cheema, Asim; Gutiérrez-Ibañes, Enrique; Muñoz, Antonio; Pan, Manuel; Webb, John G. (John Graydon); Herrmann, Howard C.; Kodali, Susheel; Nombela-Franco, Luis; Tamburino, Corrado; Jilaihawi, Hasan; Masson, Jean-Bernard; Brito, Fabio Sandoli de; Ferreira, Maria Cristina; Lima, Valter Correa; Mangione, José Armando; Iung, Bernard; Vahanian, Alec; Durand, Éric; Tuzcu, Murat; Hayek, Salim; Angulo-Llanos, Rocio; Gómez-Doblas, Juan José; Castillo Dominguez, Juan Carlos; Dvir, Danny; Leon, Martin B.; Garcia, Eulogio; Cobiella Carnicer, Javier; Vilacosta, Isidre; Barbanti, Marco; Makkar, Rajendra; Barbosa Ribeiro, HenriqueUrena Alcazar, MarinaDumont, ÉricPibarot, Philippe; López Diez, Javier; San Román, Alberto; Rodés-Cabau, Josep
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.
Document Type: Article de recherche
Issue Date: 9 March 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: Circulation, Vol. 131 (18), 1566–1574 (2015)
American Heart Association
Alternative version: 10.1161/CIRCULATIONAHA.114.014089
Collection:Articles publiés dans des revues avec comité de lecture

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