Infective Endocarditis After Transcatheter Aortic Valve Replacement.

Stortecky, Stefan; Heg, Dik; Tueller, David; Pilgrim, Thomas; Muller, Olivier; Noble, Stephane; Jeger, Raban; Toggweiler, Stefan; Ferrari, Enrico; Taramasso, Maurizio; Maisano, Francesco; Hoeller, Rebeca; Wenaweser, Peter; Nietlispach, Fabian; Widmer, Andreas; Huber, Christoph; Roffi, Marco; Carrel, Thierry; Windecker, Stephan and Conen, Anna (2020). Infective Endocarditis After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 75(24), pp. 3020-3030. Elsevier 10.1016/j.jacc.2020.04.044

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BACKGROUND

Infective endocarditis may affect patients after transcatheter aortic valve replacement (TAVR).

OBJECTIVES

The purpose of this study was to provide detailed information on incidence rates, types of microorganisms, and outcomes of infective endocarditis after TAVR.

METHODS

Between February 2011 and July 2018, consecutive patients from the SwissTAVI Registry were eligible. Infective endocarditis was classified into early (peri-procedural [<100 days] and delayed-early [100 days to 1 year]) and late (>1 year) endocarditis. Clinical events were adjudicated according to the Valve Academic Research Consortium-2 endpoint definitions.

RESULTS

During the observational period, 7,203 patients underwent TAVR at 15 hospitals in Switzerland. During follow-up of 14,832 patient-years, endocarditis occurred in 149 patients. The incidence for peri-procedural, delayed-early, and late endocarditis after TAVR was 2.59, 0.71, and 0.40 events per 100 person-years, respectively. Among patients with early endocarditis, Enterococcus species were the most frequently isolated microorganisms (30.1%). Among those with peri-procedural endocarditis, 47.9% of patients had a pathogen that was not susceptible to the peri-procedural antibiotic prophylaxis. Younger age (subhazard ratio [SHR]: 0.969; 95% confidence interval [CI]: 0.944 to 0.994), male sex (SHR: 1.989; 95% CI: 1.403 to 2.818), lack of pre-dilatation (SHR: 1.485; 95% CI: 1.065 to 2.069), and treatment in a catheterization laboratory as opposed to hybrid operating room (SHR: 1.648; 95% CI: 1.187 to 2.287) were independently associated with endocarditis. In a case-control matched analysis, patients with endocarditis were at increased risk of mortality (hazard ratio: 6.55; 95% CI: 4.44 to 9.67) and stroke (hazard ratio: 4.03; 95% CI: 1.54 to 10.52).

CONCLUSIONS

Infective endocarditis after TAVR most frequently occurs during the early period, is commonly caused by Enterococcus species, and results in considerable risks of mortality and stroke. (NCT01368250).

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