Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement
Authors: Panagides Vassili , del Val David , Abdel-Wahab Mohamed , Mangner Norman , Durand Eric , Ihlemann Nikolaj , Urena Marina , Pellegrini Costanza , Giannini Francesco , Gasior Tomasz , Wojakowski Wojtek , Landt Martin , Auffret Vincent , Sinning Jan Malte , Cheema Asim N , Nombela-Franco Luis , Chamandi Chekrallah , Campelo-Parada Francisco , Munoz-Garcia Erika , Herrmann Howard C , Testa Luca , Kim Won Keun , Castillo Juan Carlos , Alperi Alberto , Tchetche Didier , Bartorelli Antonio L , 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 , Kappert Utz , Barbanti Marco , Masson Jean Bernard , Maes Frédéric , Fiorina Claudia , Miceli Antonio , Kodali Susheel , Ribeiro Henrique B , Mangione Jose Armando , Sandoli de Brito Fabio , Actis Dato Guglielmo Mario , Rosato Francesco , Ferreira Maria Cristina , Correia de Lima Valter , Colafranceschi Alexandre Siciliano , Abizaid Alexandre , Marino Marcos Antonio , Esteves Vinicius , Andrea Julio , Godinho Roger R , Alfonso Fernando , 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 , Gervais Philippe , Linke Axel , Crusius Lisa , Holzhey David , Rodés-Cabau Josep 
Published: December 2021

Abstract

Background
Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.

Methods
This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53–421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula.

Results
A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27–3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57–4.69; P &lt; .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, P &lt; .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj &lt; 0.05 for all).

Conclusions
PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.