Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement.

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; Testa, Luca; ... (2021). Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 77(18), pp. 2276-2287. Elsevier 10.1016/j.jacc.2021.03.233

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Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR).


The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization.


Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]).


A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47).


Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Stortecky, Stefan


600 Technology > 610 Medicine & health








Nadia Biscozzo

Date Deposited:

21 Jan 2022 10:45

Last Modified:

05 Dec 2022 15:59

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

TAVR infective endocarditis prosthetic valve endocarditis stroke transcatheter aortic valve implantation




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