Key result
Infective endocarditis after TAVI had a 75.2% unadjusted 5-year mortality compared to 57.2% for non-TAVI prosthetic valve and 53.6% for native valve IE, with no significant adjusted difference.
Why the study?
IE after TAVI carries high mortality and surgery is rarely performed, prompting investigation into patient characteristics and microbiology to inform prevention and treatment.
What are the patient characteristics, microbiology, and mortality of infective endocarditis after TAVI compared to non-TAVI prosthetic valve and native valve endocarditis?
Cohort (n=6,671)
Yes
What are the patient characteristics, microbiology, and mortality of infective endocarditis after TAVI compared to non-TAVI prosthetic valve and native valve endocarditis?
Patients with infective endocarditis after TAVI are older and frailer with a higher prevalence of Enterococcus species, though adjusted short-term mortality is comparable to other types of endocarditis.
Answers are grounded in this paper and cite their sources.
Similar adjusted short-term mortality across IE types; leaves open whether frailty or microbiology drive long-term differences in TAVI patients.
BACKGROUND: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI. METHODS: Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared. RESULTS: We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age: 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates. CONCLUSIONS: Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.
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Strange et al. (2023) conducted a cohort in Infective endocarditis (n=6,671). Transcatheter aortic valve implantation (TAVI) vs. Non-TAVI prosthetic valve (nTPV) and native valve was evaluated on 5-year mortality. Infective endocarditis after TAVI had a 75.2% unadjusted 5-year mortality compared to 57.2% for non-TAVI prosthetic valve and 53.6% for native valve IE, with no significant adjusted difference.
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