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Very early infective endocarditis after transcatheter aortic valve replacement

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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.

Graphical abstract

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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Abbreviations

D-IE:

Delayed infective endocarditis

IE:

Infective endocarditis

IQR:

Interquartile range

PVE:

Prosthetic valve endocarditis

TAVR:

Trans-catheter aortic valve replacement

THV:

Trans-catheter heart valve

VE-IE:

Very early infective endocarditis

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Acknowledgements

We would like to acknowledge the Infectious Endocarditis after TAVR International Registry Investigators for their substantial contribution to data collection and research (the list of investigators is available in the supplemental material). Dr Rodés-Cabau holds the Research Chair "Fondation Famille Jacques Larivière" for the Development of Structural Heart Disease Interventions. Dr. Panagides has received a research grant from the “Mediterranean Academic Research and Studies in Cardiology” association (MARS Cardio).

Funding

There was no specific funding for this study.

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Correspondence to Josep Rodés-Cabau.

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Conflict of interest

Josep Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Vassili Panagides has received institutional research grants from Medtronic, Boston Scientific and Microport. C. Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic and consulting fees from Edwards Lifesciences and Medtronic. Jan Malte Sinning reports speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic and research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside the submitted work. Kim Won-Keun reports personal fees from Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, and Meril, outside the submitted work. Oliver Husser reports personal fees from Boston Scientific and payments from Abbott. Norman Mangner reports personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, and Bayer, outside the submitted work. All other authors report no potential conflicts.

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Panagides, V., Abdel-Wahab, M., Mangner, N. et al. Very early infective endocarditis after transcatheter aortic valve replacement. Clin Res Cardiol 111, 1087–1097 (2022). https://doi.org/10.1007/s00392-022-01998-0

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  • DOI: https://doi.org/10.1007/s00392-022-01998-0

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