Risk of endocarditis after transcatheter aortic valve implantation (TAVI) in patients under hemodialysis

Objectives Endocarditis is a known complication after TAVI, but no data are published in the group of patients under hemodialysis, who are at high risk[1, 2]. We aimed to assess the short and long-term risk for endocarditis after transcatheter aortic valve implantation (TAVI) in patients on hemodialysis based on German administrative claims data. Methods Administrative claims data of patients undergoing transvascular TAVI between 2013 and 2023 and follow up until 2023 derived from the largest provider of statutory health-care insurance (Allgemeine Ortskrankenkasse [AOK]) in Germany were used. Age, sex and risk adjusted odds ratios of endocarditis for chronic hemodialysis compared to no hemodialysis was calculated in the initial hospital stay and after 30 days and one year of discharge. Variables included for risk adjustment were age, sex, cardiac surgery, NYHA class, atrial fibrillation, acute myocardial infarction, acute stroke, cardiogenic shock, diabetes, COPD and arterial hypertension. Results A total of 71,450 patients were included in the analysis. Of those, 2,970 (4.2%) were on hemodialysis (see table for details). The raw frequency of endocarditis was 2.2% in hemodialysis patients compared to 1.0% in others within one year (see figure). The odds ratio for endocarditis in the full adjusted model was 4.52 (3.03-6.74) during index hospitalization, 3.29 (2.29-4.75) within 30 days after discharge and 1.70 (1.27-2.26) within one year. Sensitivity analyses including dialysis mode and vascular access did not change the results significantly. Conclusions Patients on hemodialysis have a significant elevated risk for endocarditis after TAVI, which is highest in the acute phase. Interventional studies are needed to evaluate prophylactic use of antibiotic treatment, i.e. during the first 30 days after TAVI.