TY - JOUR

T1 - Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

AU - del Val, David

AU - Abdel-Wahab, Mohamed

AU - Mangner, Norman

AU - Durand, Eric

AU - Ihlemann, Nikolaj

AU - Urena, Marina

AU - Pellegrini, Costanza

AU - Giannini, Francesco

AU - Gasior, Tomasz

AU - Wojakowski, Wojtek

AU - Landt, Martin

AU - Auffret, Vincent

AU - Sinning, Jan Malte

AU - Cheema, Asim N.

AU - Nombela-Franco, Luis

AU - Chamandi, Chekrallah

AU - Campelo-Parada, Francisco

AU - Munoz-Garcia, Erika

AU - Herrmann, Howard C.

AU - Testa, Luca

AU - Won-Keun, Kim

AU - Castillo, Juan Carlos

AU - Alperi, Alberto

AU - Tchetche, Didier

AU - Bartorelli, Antonio L.

AU - Kapadia, Samir

AU - Stortecky, Stefan

AU - Amat-Santos, Ignacio

AU - Wijeysundera, Harindra C.

AU - Lisko, John

AU - Gutiérrez-Ibanes, Enrique

AU - Serra, Vicenç

AU - Salido, Luisa

AU - Alkhodair, Abdullah

AU - Livi, Ugolino

AU - Chakravarty, Tarun

AU - Lerakis, Stamatios

AU - Vilalta, Victoria

AU - Regueiro, Ander

AU - Romaguera, Rafael

AU - Kappert, Utz

AU - Barbanti, Marco

AU - Masson, Jean Bernard

AU - Maes, Frédéric

AU - Fiorina, Claudia

AU - Miceli, Antonio

AU - Kodali, Susheel

AU - Ribeiro, Henrique B.

AU - Mangione, Jose Armando

AU - Sandoli de Brito, Fabio

AU - Actis Dato, Guglielmo Mario

AU - Rosato, Francesco

AU - Ferreira, Maria Cristina

AU - Correia de Lima, Valter

AU - Colafranceschi, Alexandre Siciliano

AU - Abizaid, Alexandre

AU - Marino, Marcos Antonio

AU - Esteves, Vinicius

AU - Andrea, Julio

AU - Godinho, Roger R.

AU - Alfonso, Fernando

AU - Eltchaninoff, Helene

AU - Søndergaard, Lars

AU - Himbert, Dominique

AU - Husser, Oliver

AU - Latib, Azeem

AU - Le Breton, Hervé

AU - Servoz, Clement

AU - Pascual, Isaac

AU - Siddiqui, Saif

AU - Olivares, Paolo

AU - Hernandez-Antolin, Rosana

AU - Webb, John G.

AU - Sponga, Sandro

AU - Makkar, Raj

AU - Kini, Annapoorna S.

AU - Boukhris, Marouane

AU - Gervais, Philippe

AU - Linke, Axel

AU - Crusius, Lisa

AU - Holzhey, David

AU - Rodés-Cabau, Josep

N1 - Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021

Y1 - 2021

N2 - Background: Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). Objectives: The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. Methods: Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). Results: A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). Conclusions: Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.

AB - Background: Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). Objectives: The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. Methods: Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). Results: A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). Conclusions: Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.

KW - infective endocarditis

KW - prosthetic valve endocarditis

KW - stroke

KW - TAVR

KW - transcatheter aortic valve implantation

U2 - 10.1016/j.jacc.2021.03.233

DO - 10.1016/j.jacc.2021.03.233

M3 - Journal article

C2 - 33958124

AN - SCOPUS:85104583299

VL - 77

SP - 2276

EP - 2287

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 18

ER -