Journal article
Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.
- Regueiro A Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
- Linke A Heart Center, Leipzig University, Leipzig, Germany.
- Latib A EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
- Ihlemann N Rigshospitalet, Copenhagen, Denmark.
- Urena M Bichat Hôpital, AP-HP, University Paris Diderot, France.
- Walther T Kerckhoff Klinik, Bad Nauheim, Germany.
- Husser O Deutsches Herzzentrum München, Technische Universität München, DZHK, partner site Munich Heart Alliance, Munich, Germany.
- Herrmann HC Hospital of the University of Pennsylvania, Philadelphia.
- Nombela-Franco L Hospital Universitario Clinico San Carlos, Madrid, Spain.
- Cheema AN St Michaels Hospital, Toronto, Canada.
- Le Breton H Centre Hospitalier Universitaire de Rennes, Rennes, France.
- Stortecky S Bern University Hospital (on behalf of Swiss TAVI Registry Centres), Bern, Switzerland.
- Kapadia S Cleveland Clinic, Cleveland, Ohio.
- Bartorelli AL Centro Cardiologico Monzino, Milan, Italy.
- Sinning JM Heart Center Bonn, Bonn, Germany.
- Amat-Santos I Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
- Munoz-Garcia A Hospital Universitario Virgen de la Victoria, Malaga, Spain.
- Lerakis S Emory University School of Medicine, Atlanta, Georgia.
- Gutiérrez-Ibanes E Hospital Gregorio Maranon, Madrid, Spain.
- Abdel-Wahab M Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
- Tchetche D Clinique Pasteur, Toulouse, France.
- Testa L IRCCS Pol. San Donato, Milan, Italy.
- Eltchaninoff H Hôpital Charles Nicolle, University of Rouen, INSERM U1096, France.
- Livi U Department of Cardiothoracic Surgery, University Hospital of Udine, Italy.
- Castillo JC Hospital Universitario Reina Sofia, Cordoba, Spain.
- Jilaihawi H Cedars-Sinai Heart Institute, Los Angeles, California.
- Webb JG St Pauls Hospital, Vancouver, British Columbia, Canada.
- Barbanti M Ferrarotto Hospital, Catania, Italy.
- Kodali S Columbia University Medical Center, New York, New York.
- de Brito FS Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
- Ribeiro HB Heart Institute (InCor), Sao Paulo, Brazil.
- Miceli A Fondazione Toscana G. Monasterio, Massa, Italy.
- Fiorina C Spedali Civili di Brescia, Brescia, Italy.
- Dato GM Ospedale Mauriziano, Torino, Italy.
- Rosato F Azienda Ospedaliera, S. Croce e Carle Cuneo, Cuneo, Italy.
- Serra V Hospital Vall d'Hebron, Barcelona, Spain.
- Masson JB Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
- Wijeysundera HC Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
- Mangione JA Hospital Beneficencia Portuguesa, Sao Paulo, Brazil.
- Ferreira MC Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.
- Lima VC Hospital São Francisco-Santa Casa de Misericórdia de Porto Alegre, Brazil.
- Carvalho LA Hospital Pró-cardíaco, Rio de Janeiro, Brazil.
- Abizaid A Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
- Marino MA Hospital Madre Teresa, Belo Horizonte, Brazil.
- Esteves V Hospital Sao Luiz, Sao Paulo, Brazil.
- Andrea JC Clínica Sao Vicente, Rio de Janeiro, Brazil.
- Giannini F EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
- Messika-Zeitoun D Bichat Hôpital, AP-HP, University Paris Diderot, France.
- Himbert D Bichat Hôpital, AP-HP, University Paris Diderot, France.
- Kim WK Kerckhoff Klinik, Bad Nauheim, Germany.
- Pellegrini C Deutsches Herzzentrum München, Technische Universität München, DZHK, partner site Munich Heart Alliance, Munich, Germany.
- Auffret V Centre Hospitalier Universitaire de Rennes, Rennes, France.
- Nietlispach F University Hospital Zurich, Zurich, Switzerland.
- Pilgrim T Bern University Hospital (on behalf of Swiss TAVI Registry Centres), Bern, Switzerland.
- Durand E Hôpital Charles Nicolle, University of Rouen, INSERM U1096, France.
- Lisko J Emory University School of Medicine, Atlanta, Georgia.
- Makkar RR Cedars-Sinai Heart Institute, Los Angeles, California.
- Lemos PA Heart Institute (InCor), Sao Paulo, Brazil.
- Leon MB Columbia University Medical Center, New York, New York.
- Puri R Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
- San Roman A Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
- Vahanian A Bichat Hôpital, AP-HP, University Paris Diderot, France.
- Søndergaard L Rigshospitalet, Copenhagen, Denmark.
- Mangner N Heart Center, Leipzig University, Leipzig, Germany.
- Rodés-Cabau J Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
- 2016-09-14
Published in:
- JAMA. - 2016
Age Factors
Aged
Endocarditis
Endocarditis, Bacterial
Female
Follow-Up Studies
Heart Failure
Hospital Mortality
Humans
Male
Odds Ratio
Registries
Risk Factors
Sex Factors
Staphylococcal Infections
Staphylococcus aureus
Transcatheter Aortic Valve Replacement
Treatment Outcome
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1001/jama.2016.12347
- PMID 27623462
- Persistent URL
- https://sonar.ch/global/documents/427
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