Infective endocarditis after transcatheter aortic valve implantation : a nationwide study
(2019) In European Heart Journal 40(39). p.3263-3269- Abstract
AIMS : Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study. METHODS AND RESULTS : Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with... (More)
AIMS : Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study. METHODS AND RESULTS : Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0-1.8%) the first year and 0.8% (0.6-1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49-68%), and 5-year survival was 29% (17-41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality. CONCLUSION : The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients. CLINICAL TRIAL REGISTRATION: NCT03768180 (http://clinicaltrials.gov/).
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- author
- Bjursten, Henrik LU ; Rasmussen, Magnus LU ; Nozohoor, Shahab LU ; Götberg, Mattias LU ; Olaison, Lars ; Rück, Andreas and Ragnarsson, Sigurdur LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Prosthetic valve endocarditis, Transcatheter aortic valve implantation
- in
- European Heart Journal
- volume
- 40
- issue
- 39
- pages
- 7 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:31433472
- scopus:85073183991
- ISSN
- 1522-9645
- DOI
- 10.1093/eurheartj/ehz588
- project
- Outcome after transcatheter valve interventions
- Transcatheter treatment of structural heart disease
- language
- English
- LU publication?
- yes
- id
- c8a56ed8-673b-4bdc-bdb7-e877870cc551
- date added to LUP
- 2019-10-21 12:34:36
- date last changed
- 2024-04-16 21:44:40
@article{c8a56ed8-673b-4bdc-bdb7-e877870cc551,
abstract = {{<p>AIMS : Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study. METHODS AND RESULTS : Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0-1.8%) the first year and 0.8% (0.6-1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49-68%), and 5-year survival was 29% (17-41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality. CONCLUSION : The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients. CLINICAL TRIAL REGISTRATION: NCT03768180 (http://clinicaltrials.gov/).</p>}},
author = {{Bjursten, Henrik and Rasmussen, Magnus and Nozohoor, Shahab and Götberg, Mattias and Olaison, Lars and Rück, Andreas and Ragnarsson, Sigurdur}},
issn = {{1522-9645}},
keywords = {{Prosthetic valve endocarditis; Transcatheter aortic valve implantation}},
language = {{eng}},
number = {{39}},
pages = {{3263--3269}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal}},
title = {{Infective endocarditis after transcatheter aortic valve implantation : a nationwide study}},
url = {{http://dx.doi.org/10.1093/eurheartj/ehz588}},
doi = {{10.1093/eurheartj/ehz588}},
volume = {{40}},
year = {{2019}},
}