Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement.

Panagides, Vassili; Del Val, David; Abdel-Wahab, Mohamed; Mangner, Norman; Durand, Eric; Ihlemann, Nikolaj; Urena, Marina; Pellegrini, Costanza; Giannini, Francesco; Gasior, Tomasz; Wojakowski, Wojtek; Landt, Martin; Auffret, Vincent; Sinning, Jan Malte; Cheema, Asim N; Nombela-Franco, Luis; Chamandi, Chekrallah; Campelo-Parada, Francisco; Munoz-Garcia, Erika; Herrmann, Howard C; ... (2022). Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clinical infectious diseases, 75(4), pp. 638-646. Oxford University Press 10.1093/cid/ciab1004

Preview

Text Perivalvular.pdf - Accepted Version Available under License Publisher holds Copyright. Download (1MB) | Preview

BACKGROUND

Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.

METHODS

This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings.

RESULTS

A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all).

CONCLUSION

PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.

Interest & Impact

Downloads

75 since deposited on 21 Jan 2022
74 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item