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Infective endocarditis after transcatheter aortic valve implantation: a nationwide study

Journal article
Authors H. Bjursten
M. Rasmussen
S. Nozohoor
M. Gotberg
Lars Olaison
A. Ruck
S. Ragnarsson
Published in European Heart Journal
Volume 40
Issue 39
Pages 3263-3269
ISSN 0195-668X
Publication year 2019
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 3263-3269
Language en
Links dx.doi.org/10.1093/eurheartj/ehz588
Keywords Transcatheter aortic valve implantation, Prosthetic valve endocarditis, heart-valve, risk, replacement, association, guidelines, management, diagnosis, society, esc, Cardiovascular System & Cardiology
Subject categories Cardiovascular medicine

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 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.

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