Sandra Santos-Martínez1, Abdullah Alkhodair2, Luis Nombela-Franco3, Francesco Saia4, Antonio J Muñoz-García5, Enrique Gutiérrez6, Ander Regueiro7, Victor A Jimenez-Diaz8, Fernando Rivero9, Rafael Romaguera10, Javier Gómez-Herrero11, Tania Rodriguez-Gabella12, Janarthanan Sathananthan2, Itziar Gómez Salvador13, Manuel Carrasco-Moraleja13, Josep Rodés-Cabau14, John Webb2, Javier López12, J Alberto San Román12, Ignacio J Amat-Santos15. 1. Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain. Electronic address: https://twitter.com/drassantos. 2. St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 3. Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain. 4. Division of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy. 5. CIBERCV, Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain. 6. CIBERCV, Cardiology Department, Hospital Gregorio Marañón, Madrid, Spain. 7. Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. 8. CIBERCV, Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain. 9. Cardiology Department, Hospital La Princesa, Madrid, Spain. 10. Cardiology Department, Hospital Universitari de Bellvitge - IDIBELL, Universitat de Barcelona. Barcelona, Spain. 11. Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain. 12. Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain. 13. Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain. 14. Quebec Heart & Lung Institute, Quebec City, Quebec, Canada. 15. Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain. Electronic address: ijamat@gmail.com.
Abstract
OBJECTIVES: This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment. BACKGROUND: Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended. METHODS: This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs). RESULTS: Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure. CONCLUSIONS: TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.
OBJECTIVES: This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment. BACKGROUND:Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended. METHODS: This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs). RESULTS: Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure. CONCLUSIONS: TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.