Very early infective endocarditis after transcatheter aortic valve replacement

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Vassili Panagides
  • Mohamed Abdel-Wahab
  • Norman Mangner
  • Eric Durand
  • Nikolaj Ihlemann
  • Marina Urena
  • Costanza Pellegrini
  • Francesco Giannini
  • Piotr Scislo
  • Zenon Huczek
  • Martin Landt
  • Vincent Auffret
  • Jan Malte Sinning
  • Asim N. Cheema
  • Luis Nombela-Franco
  • Chekrallah Chamandi
  • Francisco Campelo-Parada
  • Erika Munoz-Garcia
  • Howard C. Herrmann
  • Luca Testa
  • Won Keun Kim
  • Helene Eltchaninoff
  • Dominique Himbert
  • Oliver Husser
  • Azeem Latib
  • Hervé Le Breton
  • Clement Servoz
  • Philippe Gervais
  • David del Val
  • Axel Linke
  • Lisa Crusius
  • Holger Thiele
  • David Holzhey
  • Josep Rodés-Cabau

Background: Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). Objective: The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. Methods: This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. Results: Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. Conclusion: A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Graphical abstract: Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis. [Figure not available: see fulltext.].

OriginalsprogEngelsk
TidsskriftClinical Research in Cardiology
Vol/bind111
Sider (fra-til)1087–1097
ISSN1861-0684
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
We would like to acknowledge the Infectious Endocarditis after TAVR International Registry Investigators for their substantial contribution to data collection and research (the list of investigators is available in the supplemental material). Dr Rodés-Cabau holds the Research Chair "Fondation Famille Jacques Larivière" for the Development of Structural Heart Disease Interventions. Dr. Panagides has received a research grant from the “Mediterranean Academic Research and Studies in Cardiology” association (MARS Cardio).

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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