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 a total of 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 confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. 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 (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was 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<0.001). 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 risk 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). Conclusion: 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 very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement / V. Panagides, D. Del Val, M. Abdel-Wahab, N. Mangner, E. Durand, N. Ihlemann, M. Urena, C. Pellegrini, F. Giannini, T. Gasior, W. Wojakowski, M. Landt, V. Auffret, J.M. Sinning, A.N. Cheema, L. Nombela-Franco, C. Chamandi, F. Campelo-Parada, E. Munoz-Garcia, H.C. Herrmann, L. Testa, K. Won-Keun, J.C. Castillo, A. Alperi, D. Tchetche, A.L. Bartorelli, S. Kapadia, S. Stortecky, I. Amat-Santos, H.C. Wijeysundera, J. Lisko, E. Gutiérrez-Ibanes, V. Serra, L. Salido, A. Alkhodair, U. Livi, T. Chakravarty, S. Lerakis, V. Vilalta, A. Regueiro, R. Romaguera, U. Kappert, M. Barbanti, J. Masson, F. Maes, C. Fiorina, A. Miceli, S. Kodali, H.B. Ribeiro, J.A. Mangione, F. Sandoli de Brito, G.M. Actis Dato, F. Rosato, M. Ferreira, V. Correia de Lima, A.S. Colafranceschi, A. Abizaid, M.A. Marino, V. Esteves, J. Andrea, R.R. Godinho, F. Alfonso, H. Eltchaninoff, L. Søndergaard, D. Himbert, O. Husser, A. Latib, H. Le Breton, C. Servoz, I. Pascual, S. Siddiqui, P. Olivares, R. Hernandez-Antolin, J.G. Webb, S. Sponga, R. Makkar, A.S. Kini, M. Boukhris, P. Gervais, A. Linke, L. Crusius, D. Holzhey, J. Rodés-Cabau. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - (2021). [Epub ahead of print] [10.1093/cid/ciab1004]
Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement
A.L. Bartorelli;A. Miceli;P. Olivares;
2021
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 a total of 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 confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. 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 (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was 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<0.001). 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 risk 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). Conclusion: 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 very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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