Infective Endocarditis Following Transcatheter Aortic Valve Implantation: Results from a Large Multicenter Registry
Background—We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of IE after TAVI.
Methods and Results—This multicenter registry included 53 patients (mean age 79±8 years, men: 57%) who suffered IE following TAVI of 7,944 patients after a mean follow-up of 1.1±1.2 years (incidence of 0.67%; 0.50% within the first year post-TAVI). Mean time from TAVI was 6 (IQR: 1-14) months. Orotracheal intubation (HR: 3.87, 95%CI: 1.55-9.64, P=.004) and the self-expandable CoreValve system (HR: 3.12, 95% CI: 1.37-7.14, P=.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets: 39%, stent frame: 17%, mitral valve: 21%). At least one complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve in 4 and 2 patients, respectively). The in-hospital mortality rate was 47.2%, and increased up to 66% at 1-year follow-up. IE complications such as heart failure (p=0.037) or septic shock (p=0.002) were associated with increased in-hospital mortality.
Conclusions—The incidence of IE at 1-year after TAVI was of 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphyloccoci and enteroccoci were the most common agents. While most patients presented at least one complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.
- Received November 2, 2014.
- Revision received February 20, 2015.
- Accepted February 24, 2015.