Prosthetic valve endocarditis after transcatheter aortic valve implantation
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Prosthetic valve endocarditis after transcatheter aortic valve implantation. / Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H; Vejlstrup, Niels Grove; Bundgård, Henning; Søndergaard, Lars; Ihlemann, Nikolaj.
I: Circulation: Cardiovascular Interventions, Bind 8, Nr. 4, e001939 , 04.2015, s. 1-10.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Prosthetic valve endocarditis after transcatheter aortic valve implantation
AU - Olsen, Niels Thue
AU - De Backer, Ole
AU - Thyregod, Hans G H
AU - Vejlstrup, Niels Grove
AU - Bundgård, Henning
AU - Søndergaard, Lars
AU - Ihlemann, Nikolaj
N1 - © 2015 American Heart Association, Inc.
PY - 2015/4
Y1 - 2015/4
N2 - BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural risk factors.METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years (interquartile range, 0.5-2.5 years; longest follow-up was 6.3 years). TAVI-PVE was most frequent in the first year after implantation (first-year incidence, 3.1% [confidence interval, 1.4%-4.8%]); the overall annualized rate was 2.1% per patient-year (confidence interval, 1.2%-3.3%). Seventeen patients (94%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]).CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves. Conservative treatment was associated with an acceptable outcome. Suboptimal valve deployment and vascular complications were associated with an increased risk of TAVI-PVE.
AB - BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural risk factors.METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years (interquartile range, 0.5-2.5 years; longest follow-up was 6.3 years). TAVI-PVE was most frequent in the first year after implantation (first-year incidence, 3.1% [confidence interval, 1.4%-4.8%]); the overall annualized rate was 2.1% per patient-year (confidence interval, 1.2%-3.3%). Seventeen patients (94%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]).CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves. Conservative treatment was associated with an acceptable outcome. Suboptimal valve deployment and vascular complications were associated with an increased risk of TAVI-PVE.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve Stenosis
KW - Denmark
KW - Endocarditis, Non-Infective
KW - Female
KW - Follow-Up Studies
KW - Heart Valve Prosthesis
KW - Humans
KW - Incidence
KW - Male
KW - Postoperative Complications
KW - Risk Factors
KW - Survival Analysis
KW - Transcatheter Aortic Valve Replacement
KW - Treatment Outcome
U2 - 10.1161/CIRCINTERVENTIONS.114.001939
DO - 10.1161/CIRCINTERVENTIONS.114.001939
M3 - Journal article
C2 - 25873728
VL - 8
SP - 1
EP - 10
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
SN - 1941-7640
IS - 4
M1 - e001939
ER -
ID: 162252353