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- Title
Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement.
- Authors
Panagides, Vassili; Val, David del; Abdel-Wahab, Mohamed; Mangner, Norman; Durand, Eric; Ihlemann, Nikolaj; Urena, Marina; Pellegrini, Costanza; Giannini, Francesco; Gasior, Tomasz; Wojakowski, Wojtek; Landt, Martin; Auffret, Vincent; Sinning, Jan Malte; Cheema, Asim N; Nombela-Franco, Luis; Chamandi, Chekrallah; Campelo-Parada, Francisco; Munoz-Garcia, Erika; Herrmann, Howard C
- 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 (p adj < 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.
- Subjects
RESEARCH; CHRONIC kidney failure; RANGE of motion of joints; HEART valve prosthesis implantation; CONFIDENCE intervals; INFECTIVE endocarditis; RISK assessment; DESCRIPTIVE statistics; CHI-squared test; FALSE aneurysms; ODDS ratio; AORTIC valve; DISEASE risk factors; DISEASE complications
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 4, p638
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab1004