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Circulation. 2015 May 5;131(18):1566-74. doi: 10.1161/CIRCULATIONAHA.114.014089. Epub 2015 Mar 9.

Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry.

Author information

1
From Quebec Heart & Lung Institute, Quebec, Canada (I.J.A.-S., H.B.R., M.U., E.D., P.P., J.R.-C.); Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., J.L, A.S.R.); Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.M.-Z., B.I., A.V.); Hôpital Charles Nicolle, University of Rouen, France (H.E., E.D.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia, E.M.T.); Emory University School of Medicine, Division of Cardiology, Atlanta, GA (S.L., S.S.H.); St. Michael's Hospital Toronto, ON, Canada (A.C.); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (E.G.-I., R.A.-L.); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., J.J.G.-D.); Hospital Universitario Reina Sofía, Córdoba, Spain (M.P., J.C.C.); St. Paul's Hospital, Vancouver, BC, Canada (J.G.W., D.D.); Hospital of the University of Pennsylvania, Philadelphia (H.H.); Columbia University Medical Center/New York Presbyterian Hospital, NY (S. Kodali, M.B.L.); Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., E.G., J.C., I.V.); Ferrarotto Hospital, University of Catania, Italy (C.T., M.B.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J., R.M.); Centre Hospitalier de l'Université de Montréal, QC, Canada (J.-B.M.); Hospital Israelita Albert Einstein, Sao Paulo, Brazil (F.S.d.B.); Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil (M.C.F.); Hospital Sao Francisco-Santa Casa de Misericórdia, Porto Alegre, Porto Alegre, Brazil (V.C.L.); and Hospital Beneficência Portuguesa, Sao Paulo, Brazil (J.A.M.).
2
From Quebec Heart & Lung Institute, Quebec, Canada (I.J.A.-S., H.B.R., M.U., E.D., P.P., J.R.-C.); Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., J.L, A.S.R.); Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.M.-Z., B.I., A.V.); Hôpital Charles Nicolle, University of Rouen, France (H.E., E.D.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia, E.M.T.); Emory University School of Medicine, Division of Cardiology, Atlanta, GA (S.L., S.S.H.); St. Michael's Hospital Toronto, ON, Canada (A.C.); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (E.G.-I., R.A.-L.); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., J.J.G.-D.); Hospital Universitario Reina Sofía, Córdoba, Spain (M.P., J.C.C.); St. Paul's Hospital, Vancouver, BC, Canada (J.G.W., D.D.); Hospital of the University of Pennsylvania, Philadelphia (H.H.); Columbia University Medical Center/New York Presbyterian Hospital, NY (S. Kodali, M.B.L.); Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., E.G., J.C., I.V.); Ferrarotto Hospital, University of Catania, Italy (C.T., M.B.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J., R.M.); Centre Hospitalier de l'Université de Montréal, QC, Canada (J.-B.M.); Hospital Israelita Albert Einstein, Sao Paulo, Brazil (F.S.d.B.); Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil (M.C.F.); Hospital Sao Francisco-Santa Casa de Misericórdia, Porto Alegre, Porto Alegre, Brazil (V.C.L.); and Hospital Beneficência Portuguesa, Sao Paulo, Brazil (J.A.M.). josep.rodes@criucpq.ulaval.ca.

Abstract

BACKGROUND:

We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).

METHODS AND RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

endocarditis; heart valves; transcatheter aortic valve implantation

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