Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement
Vassili Panagides, David del Val, Mohamed Abdel‐Wahab, Norman Mangner, Éric Durand, Nikolaj Ihlemann, Marina Ureña, Costanza Pellegrini, Francesco Giannini, Tomasz Gąsior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela‐Franco, Chekrallah Chamandi, Francisco Campelo‐Parada, Érika Muñoz-García, Howard C Herrmann, Luca Testa, Won Keun Kim, Juan C. Castillo, Alberto Alperi, Didier Tchétché, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio J. Amat‐Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez, Vicenç Serra, Luisa Salido Tahoces, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victòria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique Barbosa Ribeiro, José Armando Mangione, Fábio Sândoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Meira Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Maynar-Mariño, Vinícius Esteves, Júlio Andrea, Roger Renault Godinho, Fernándo Alfonso, Hélène Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Hüsser, Azeem Latib, Hervé Breton, Clément Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernández‐Antolín, John Webb, Sandro Sponga, Raj Makkar, Annapoorna Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés‐Cabau
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.