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Infective endocarditis after TAVR associated with poor outcomes
Among patients undergoing transcatheter aortic valve replacement, those who developed infective endocarditis had a high rate of mortality and other poor outcomes, according to recent findings.
The researchers studied the incidence, predictors, clinical characteristics, management and outcomes in 53 patients who experienced infective endocarditis after TAVR from a cohort of 7,944 patients followed for a mean of 1.1 years. The incidence rate of infective endocarditis was 0.67% overall and 0.5% within the first year after TAVR. The mean duration between TAVR and incidence was 6 months (interquartile range, 1-14 months).
Ignacio J. Amat-Santos, MD, and colleagues performed univariate and multivariate analyses in 3,067 patients to identify predictors of infective endocarditis. They reported a nearly fourfold increase in infective endocarditis incidence among patients undergoing orotracheal intubation (HR = 3.87; 95% CI, 1.55-9.64). Patients treated with a self-expandable TAVR system (CoreValve, Medtronic) also were more likely to experience infective endocarditis (HR = 3.12; 95% CI, 1.37-7.14).
Coagulase-negative staphylococci were the most likely causative agent, with 24% of infections resulting from this microorganism, whereas Staphylococcus aureus and enterococci both caused 21% of infections, according to the researchers. Clinicians observed vegetations in 77.4% of the cohort, in the following locations: transcatheter valve leaflets, 39.6%; stent frame, 17%; and mitral valve, 20.7%. They also reported that 86.8% of patients with infective endocarditis experienced at least one complication of infective endocarditis; of those with infective endocarditis, 67.9% had HF.
Only 11.4% of those with infective endocarditis underwent valve intervention: Four patients had valve explantation and two had a valve-in-valve procedure, Amat-Santos, from the Quebec Heart and Lung Institute, Quebec City, and colleagues wrote.
In-hospital mortality was 47.2%, and 66% died within 1 year of follow-up. Further analysis indicated associations between in-hospital mortality and HF (P = .037) and septic shock (P = .002).
The most commonly reported symptoms of infective endocarditis included fever (71.7%) and HF (58.5%). Fifty-one percent of patients with infective endocarditis were exposed to a procedure associated with increased bacteremia risk before clinicians identified infective endocarditis. These included urologic, gastrointestinal and odontological sources. Exposure due to health care procedures was reported in 39.6% of exposed patients.
“The prognosis of patients with [infective endocarditis] after [TAVR] was ominous,” the researchers concluded. “While we await for future studies to determine whether a more invasive approach translates into improved outcomes in the context of [infective endocarditis] after [TAVR], a careful case-by-case evaluation by the heart team remains of major importance in such a challenging and high-risk group of patients.” – by Rob Volansky
Disclosure: Amat-Santos reports no relevant financial disclosures. See the full study for a list of all other researchers’ relevant financial disclosures.