What question did this study set out to answer?

To investigate the incidence, clinical predictors, and prognostic impact of perivalvular extension in patients who develop infective endocarditis after transcatheter aortic valve replacement.

December 9, 2021Clinical Infectious DiseasesOpen Access

Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement

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Why the study?

Infective endocarditis following TAVR is associated with a dismal prognosis, but scarce data exist regarding perivalvular extension in these patients.

Population

579 patients with definite IE following TAVR

Comparison

Patients with vs without perivalvular extension

Design

Multicenter study

Follow-up

2 years

Authors

VPVassili PanagidesHôpital privé Clairval DVDavid del ValInterventional / Structural Cardiology MAMohamed Abdel‐WahabInterventional / Structural Cardiology

Discussion

Member takes

Implication

Supports heightened vigilance for PEE in post-TAVR IE; leaves open optimal management strategies.

Key Points

To investigate the incidence, clinical predictors, and prognostic impact of perivalvular extension in patients who develop infective endocarditis after transcatheter aortic valve replacement.
Multicenter study analyzing 579 patients diagnosed with definite infective endocarditis at a median of 171 days (IQR: 53–421 days) after transcatheter aortic valve replacement (TAVR).
Perivalvular extension (PEE) was defined as the presence of an intracardiac abscess, pseudoaneurysm, fistula, or a combination of these lesions on imaging.
PEE occurred in 105 patients (18.1%), with risk independently elevated by chronic kidney disease (adjusted OR: 2.08; 95% CI: 1.27–3.41; P = .003) and coagulase-negative staphylococci infection (adjusted OR: 2.71; 95% CI: 1.57–4.69; P < .001).
In-hospital and 2-year mortality rates among patients with PEE were 36.5% and 69.4%, respectively.
Index hospitalization surgery was performed in 32.4% of PEE patients (vs 15.2% without PEE; P < .001) and was independently associated with reduced mortality (padj < 0.05).

Structured PICO

Population

579 patients with definite infective endocarditis (IE) diagnosed at a median of 171 (53-421) days following transcatheter aortic valve replacement (TAVR)

Outcome

Incidence of perivalvular extension (PEE) and in-hospital and 2-year mortalityhard clinical

Perivalvular extension complicates nearly 20% of infective endocarditis cases post-TAVR and is associated with high mortality, though surgical intervention during the index hospitalization may improve outcomes.

Cite This Study

Panagides et al. (2021) studied this question.

synapsesocial.com/papers/6a8692ca37c0fd3c5e544ae3 https://doi.org/10.1093/cid/ciab1004

Topics

Infective endocarditis Transcatheter aortic valve replacement TAVR in low-risk patients

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Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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