TY - JOUR

T1 - Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

AU - Regueiro, Ander

AU - Linke, Axel

AU - Latib, Azeem

AU - Ihlemann, Nikolaj

AU - Urena, Marina

AU - Walther, Thomas

AU - Husser, Oliver

AU - Herrmann, Howard C

AU - Nombela-Franco, Luis

AU - Cheema, Asim N

AU - Le Breton, Hervé

AU - Stortecky, Stefan

AU - Kapadia, Samir

AU - Bartorelli, Antonio L

AU - Sinning, Jan-Malte

AU - Amat-Santos, Ignacio

AU - Munoz-Garcia, Antonio

AU - Lerakis, Stamatios

AU - Gutiérrez-Ibanes, Enrique

AU - Abdel-Wahab, Mohamed

AU - Tchetche, Didier

AU - Testa, Luca

AU - Eltchaninoff, Hélène

AU - Livi, Ugolino

AU - Castillo, Juan Carlos

AU - Jilaihawi, Hasan

AU - Webb, John G

AU - Barbanti, Marco

AU - Kodali, Susheel

AU - de Brito, Fabio S

AU - Ribeiro, Henrique B

AU - Miceli, Antonio

AU - Fiorina, Claudia

AU - Dato, Guglielmo Mario Actis

AU - Rosato, Francesco

AU - Serra, Vicenç

AU - Masson, Jean-Bernard

AU - Wijeysundera, Harindra C

AU - Mangione, Jose A

AU - Ferreira, Maria-Cristina

AU - Lima, Valter C

AU - Carvalho, Luiz A

AU - Abizaid, Alexandre

AU - Marino, Marcos A

AU - Esteves, Vinicius

AU - Andrea, Julio C M

AU - Giannini, Francesco

AU - Messika-Zeitoun, David

AU - Himbert, Dominique

AU - Kim, Won-Keun

AU - Pellegrini, Costanza

AU - Auffret, Vincent

AU - Nietlispach, Fabian

AU - Pilgrim, Thomas

AU - Durand, Eric

AU - Lisko, John

AU - Makkar, Raj R

AU - Lemos, Pedro A

AU - Leon, Martin B

AU - Puri, Rishi

AU - San Roman, Alberto

AU - Vahanian, Alec

AU - Søndergaard, Lars

AU - Mangner, Norman

AU - Rodés-Cabau, Josep

PY - 2016/9/13

Y1 - 2016/9/13

N2 - IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

AB - IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

KW - Age Factors

KW - Aged

KW - Endocarditis

KW - Endocarditis, Bacterial

KW - Female

KW - Follow-Up Studies

KW - Heart Failure

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Odds Ratio

KW - Registries

KW - Risk Factors

KW - Sex Factors

KW - Staphylococcal Infections

KW - Staphylococcus aureus

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

KW - Journal Article

KW - Multicenter Study

U2 - 10.1001/jama.2016.12347

DO - 10.1001/jama.2016.12347

M3 - Journal article

C2 - 27623462

VL - 316

SP - 1083

EP - 1092

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 10

ER -