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Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry.
- Source :
-
Circulation . 5/5/2015, Vol. 131 Issue 18, p1566-1574. 9p. - Publication Year :
- 2015
-
Abstract
- <bold>Background: </bold>We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).<bold>Methods and Results: </bold>This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1-14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55-9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37-7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality.<bold>Conclusions: </bold>The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period. [ABSTRACT FROM AUTHOR]
- Subjects :
- *AORTIC stenosis
*ENTEROCOCCUS
*HEART failure
*PROSTHETIC heart valves
*INFECTION
*INFECTIVE endocarditis
*COMPLICATIONS of prosthesis
*STAPHYLOCOCCAL diseases
*SURGICAL complications
*TRACHEA intubation
*GRAM-positive bacterial infections
*RELATIVE medical risk
*TREATMENT effectiveness
*DISEASE incidence
*ACQUISITION of data
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*HOSPITAL mortality
*KAPLAN-Meier estimator
*MEDICAL equipment contamination
Subjects
Details
- Language :
- English
- ISSN :
- 00097322
- Volume :
- 131
- Issue :
- 18
- Database :
- Academic Search Index
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 113857768
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.114.014089