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Infective endocarditis after transcatheter aortic valve implantation : a nationwide study

Bjursten, Henrik LU ; Rasmussen, Magnus LU ; Nozohoor, Shahab LU ; Götberg, Mattias LU ; Olaison, Lars ; Rück, Andreas and Ragnarsson, Sigurdur LU (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
organization
publishing date
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
language
English
LU publication?
yes
id
c8a56ed8-673b-4bdc-bdb7-e877870cc551
date added to LUP
2019-10-21 12:34:36
date last changed
2020-07-08 05:05:57
@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 &lt;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 (&lt;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},
  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},
}