Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death
Authors: Ander Regueiro, Axel Linke, Azeem Latib, Nikolaj Ihlemann, Marina Urena, Thomas Walther, Oliver Husser, Howard C. Herrmann, Luis Nombela-Franco, Asim N. Cheema, Hervé Le Breton, Stefan Stortecky, Samir Kapadia, Antonio L. Bartorelli, Jan Malte Sinning, Ignacio Amat-Santos, Antonio Munoz-Garcia, Stamatios Lerakis, Enrique Gutiérrez-Ibanes, Mohamed Abdel-Wahab, Didier Tchetche, Luca Testa, Helene Eltchaninoff, Ugolino Livi, Juan Carlos Castillo, Hasan Jilaihawi, John G. Webb, Marco Barbanti, Susheel Kodali, Fabio S. de Brito, Henrique B. Ribeiro, Antonio Miceli, Claudia Fiorina, Guglielmo Mario Actis Dato, Francesco Rosato, Vicenç Serra, Jean-Bernard Masson, Harindra C. Wijeysundera, Jose A. Mangione, Maria-Cristina Ferreira, Valter C. Lima, Luiz A. Carvalho, Alexandre Abizaid, Marcos A. Marino, Vinicius Esteves, Julio C. M. Andrea, Francesco Giannini, David Messika-Zeitoun, Dominique Himbert, Won-Keun Kim, Costanza Pellegrini, Vincent Auffret, Fabian Nietlispach, Thomas Pilgrim, Eric Durand, John Lisko, Raj R. Makkar, Pedro A. Lemos, Martin B. Leon, Rishi Puri, Alberto San Roman, Alec Vahanian, Lars Søndergaard, Norman Mangner, Josep Rodés-Cabau
Journal: JAMA (2016)

<h3>Importance</h3> Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). <h3>Objective</h3> To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposure</h3> Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. <h3>Main Outcomes and Measures</h3> Infective endocarditis and in-hospital mortality after infective endocarditis. <h3>Results</h3> 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.<i>Enterococci</i>species and<i>Staphylococcus aureus</i>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). <h3>Conclusions and Relevance</h3> 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.