Vassili Panagides1, Mohamed Abdel-Wahab2,3, Norman Mangner2,4, Eric Durand5, Nikolaj Ihlemann6, Marina Urena7, Costanza Pellegrini8, Francesco Giannini9,10, Piotr Scislo11, Zenon Huczek11, Martin Landt3, Vincent Auffret12, Jan Malte Sinning13, Asim N Cheema14,15, Luis Nombela-Franco16, Chekrallah Chamandi17, Francisco Campelo-Parada18, Erika Munoz-Garcia19, Howard C Herrmann20, Luca Testa21, Won-Keun Kim22, Helene Eltchaninoff5, Lars Søndergaard6, Dominique Himbert7, Oliver Husser8,23, Azeem Latib9,24, Hervé Le Breton12, Clement Servoz18, Philippe Gervais1, David Del Val1, Axel Linke2,4, Lisa Crusius2,4, Holger Thiele2, David Holzhey2, Josep Rodés-Cabau25,26. 1. Quebec Heart and Lung Institute, Laval University, Quebec City, Canada. 2. Heart Center, Leipzig University, Leipzig, Germany. 3. Heart Center, Segeberger Kliniken, Bad Segeberg, Germany. 4. Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany. 5. Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France. 6. Righospitalet, Copenhagen, Denmark. 7. Bichat Hôpital, Paris, France. 8. Deutsches Herzzentrum München, Munich, Germany. 9. Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy. 10. Ospedale San Raffaele, Milan, Italy. 11. Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 12. Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France. 13. Heart Center Bonn, Bonn, Germany. 14. St Michaels Hospital, Toronto, Canada. 15. Southlake Hospital, Newmarket, ON, Canada. 16. Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. 17. Hôpital Européen Georges-Pompidou, Paris, France. 18. Hôpital Rangueil, Toulouse, France. 19. Hospital Universitario Virgen de la Victoria, Malaga, Spain. 20. Hospital of the University of Pennsilvania, Philadelphia, USA. 21. IRCCS Pol, San Donato, Milan, Italy. 22. Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany. 23. Augustinum Klinik München, München, Germany. 24. Montefiore Medical Center, New York, NY, USA. 25. Quebec Heart and Lung Institute, Laval University, Quebec City, Canada. josep.rodes@criucpq.ulaval.ca. 26. Hospital Clínic Barcelona, Barcelona, Spain. josep.rodes@criucpq.ulaval.ca.
Abstract
BACKGROUND: Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). OBJECTIVE: The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. METHODS: This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS: Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. CONCLUSION: A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.
BACKGROUND: Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). OBJECTIVE: The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. METHODS: This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS: Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. CONCLUSION: A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.
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