Key result
Infective endocarditis after TAVR is linked to ~6.5-fold higher mortality.
Why the study?
Detailed information on the incidence rates, causative microorganisms, and clinical outcomes of infective endocarditis after TAVR was needed.
What are the incidence rates, causative microorganisms, predictors, and clinical outcomes of infective endocarditis in patients undergoing transcatheter aortic valve replacement?
Cohort (n=7,203)
Yes
What are the incidence rates, causative microorganisms, predictors, and clinical outcomes of infective endocarditis in patients undergoing transcatheter aortic valve replacement?
Infective endocarditis after TAVR occurs most frequently within the first 100 days, is often caused by Enterococcus species not covered by standard antibiotic prophylaxis, and increases the risk of mortality more than six-fold and stroke four-fold.
Endocarditis after TAVR confers high mortality and stroke risk; registry data extend incidence estimates but leave prevention strategies open.
BACKGROUND Infective endocarditis may affect patients after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study was to provide detailed information on incidence rates, types of microorganisms, and outcomes of infective endocarditis after TAVR. METHODS Between February 2011 and July 2018, consecutive patients from the SwissTAVI Registry were eligible. Infective endocarditis was classified into early (peri-procedural [<100 days] and delayed-early [100 days to 1 year]) and late (>1 year) endocarditis. Clinical events were adjudicated according to the Valve Academic Research Consortium-2 endpoint definitions. RESULTS During the observational period, 7,203 patients underwent TAVR at 15 hospitals in Switzerland. During follow-up of 14,832 patient-years, endocarditis occurred in 149 patients. The incidence for peri-procedural, delayed-early, and late endocarditis after TAVR was 2.59, 0.71, and 0.40 events per 100 person-years, respectively. Among patients with early endocarditis, Enterococcus species were the most frequently isolated microorganisms (30.1%). Among those with peri-procedural endocarditis, 47.9% of patients had a pathogen that was not susceptible to the peri-procedural antibiotic prophylaxis. Younger age (subhazard ratio [SHR]: 0.969; 95% confidence interval [CI]: 0.944 to 0.994), male sex (SHR: 1.989; 95% CI: 1.403 to 2.818), lack of pre-dilatation (SHR: 1.485; 95% CI: 1.065 to 2.069), and treatment in a catheterization laboratory as opposed to hybrid operating room (SHR: 1.648; 95% CI: 1.187 to 2.287) were independently associated with endocarditis. In a case-control matched analysis, patients with endocarditis were at increased risk of mortality (hazard ratio: 6.55; 95% CI: 4.44 to 9.67) and stroke (hazard ratio: 4.03; 95% CI: 1.54 to 10.52). CONCLUSIONS Infective endocarditis after TAVR most frequently occurs during the early period, is commonly caused by Enterococcus species, and results in considerable risks of mortality and stroke. (NCT01368250).
No takes yet. Share an insight, caveat, or question.
Stortecky et al. (2020) conducted a cohort in Infective endocarditis after transcatheter aortic valve replacement (TAVR) (n=7,203). Infective endocarditis after TAVR vs. Matched TAVR patients without infective endocarditis was evaluated on Mortality (in case-control matched analysis of endocarditis vs no endocarditis) (HR 6.55, 95% CI 4.44-9.67). Infective endocarditis after TAVR occurred in 149 of 7,203 patients and significantly increased the risk of mortality (HR 6.55; 95% CI 4.44-9.67) and stroke (HR 4.03; 95% CI 1.54-10.52).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: