Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement
David del Val, Mohamed Abdel‐Wahab, Axel Linke, Éric Durand, Nikolaj Ihlemann, Marina Ureña, Costanza Pellegrini, Francesco Giannini, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela‐Franco, Chekrallah Chamandi, Francisco Campelo‐Parada, Antonio J. Muñoz-García, Howard C Herrmann, Luca Testa, Kim Won-keun, 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, 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 C. Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Maynar-Mariño, Vinícius Esteves, Júlio Andrea, Roger Renault Godinho, Hélène Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Hüsser, Azeem Latib, Hervé Breton, Clément Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernández‐Antolín, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna Kini, Marouane Boukhris, Norman Mangner, Lisa Crusius, David Holzhey, Josep Rodés‐Cabau
Abstract
BACKGROUND: Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS: Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS: Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS: Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.