Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement
Authors: del Val David , Abdel-Wahab Mohamed , Linke Axel , Durand Eric , Ihlemann Nikolaj , Urena Marina , Pellegrini Costanza , Giannini Francesco , Landt Martin , Auffret Vincent , Sinning Jan Malte , Cheema Asim , Nombela-Franco Luis , Chamandi Chekrallah , Campelo-Parada Francisco , Munoz-Garcia Antonio , Herrmann Howard C , Testa Luca , Won-Keun Kim , Castillo Juan Carlos , Alperi Alberto , Tchetche Didier , Bartorelli Antonio , Kapadia Samir , Stortecky Stefan , Amat-Santos Ignacio , Wijeysundera Harindra C , Lisko John , Gutiérrez-Ibanes Enrique , Serra Vicenç , Salido Luisa , Alkhodair Abdullah , Livi Ugolino , Chakravarty Tarun , Lerakis Stamatios , Vilalta Victoria , Regueiro Ander , Romaguera Rafael , Barbanti Marco , Masson Jean-Bernard , Maes Frédéric , Fiorina Claudia , Miceli Antonio , Kodali Susheel , Ribeiro Henrique B , Mangione Jose Armando , de Brito Fabio Sandoli , Actis Dato Guglielmo Mario , Rosato Francesco , Ferreira Maria-Cristina , Lima Valter Correa , Colafranceschi Alexandre Siciliano , Abizaid Alexandre , Marino Marcos Antonio , Esteves Vinicius , Andrea Julio , Godinho Roger R , Eltchaninoff Helene , Søndergaard Lars , Himbert Dominique , Husser Oliver , Latib Azeem , Le Breton Hervé , Servoz Clement , Pascual Isaac , Siddiqui Saif , Olivares Paolo , Hernandez-Antolin Rosana , Webb John G , Sponga Sandro , Makkar Raj , Kini Annapoorna S , Boukhris Marouane , Mangner Norman , Crusius Lisa , Holzhey David , Rodés-Cabau Josep 
Published: December 2020

Background

Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.

Methods

Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).

Results

Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P &lt; .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P &lt; .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P &lt; .05 for all).

Conclusions

Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.