Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. METHODS: This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula. RESULTS: A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27-3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57-4.69; P < .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, P < .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj < 0.05 for all). CONCLUSIONS: PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciab1004
Authors: Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G Webb, Sandro Sponga, Raj Makkar, Annapoorna S Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau
Institutions: Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Segeberger Kliniken, Leipzig University, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Université de Rouen Normandie, Rigshospitalet, Hôpital Bichat-Claude-Bernard, Deutsches Herzzentrum München, Maria Cecilia Hospital, IRCCS Ospedale San Raffaele, Medical University of Silesia, Centre Hospitalier Universitaire de Rennes, Université de Rennes, St. Michael's Hospital, Southlake Regional Health Center, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hôpital Européen Georges-Pompidou, Hôpital Rangueil, Hospital Clínico Universitario Virgen de la Victoria, Hospital of the University of Pennsylvania, IRCCS Policlinico San Donato, Kerckhoff Klinik, Hospital Universitario Reina Sofía, Hospital Universitario Central de Asturias, Clinique Pasteur, University of Milan, Centro Cardiologico Monzino, Cleveland Clinic, University of Bern, University Hospital of Bern, Hospital Clínico Universitario de Valladolid, Sunnybrook Health Science Centre, Emory University, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Vall d'Hebron Hospital Universitari, Hospital Universitario Ramón y Cajal, St. Paul's Hospital, University of Udine, Cedars-Sinai Smidt Heart Institute, Mount Sinai Hospital, Hospital Universitari Germans Trias i Pujol, Hospital Clínic de Barcelona, Bellvitge University Hospital, University of Catania, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Centre Hospitalier de l’Université de Montréal, Cliniques Universitaires Saint-Luc, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University Hospital Galway, Istituto Clinico Sant'Ambrogio, Columbia University Irving Medical Center, Universidade de São Paulo, Hospital Samaritano de São Paulo, Instituto do Coração - HCFMUSP, Beneficência Portuguesa de São Paulo, A. O. Ordine Mauriziano di Torino, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, Santa Casa Hospital, Hospital Pró-Cardíaco, Hospital Madre Teresa, Hospital Universitario de La Princesa, St.-Johannes-Hospital Dortmund, Montefiore Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4200517429