Author + information
- Received February 25, 2020
- Revision received May 4, 2020
- Accepted May 5, 2020
- Published online September 7, 2020.
- Amgad Mentias, MD, MSa,∗ (, )@AmgadMentias,
- Saket Girotra, MD, MPHa,
- Milind Y. Desai, MDb,
- Phillip A. Horwitz, MDa,
- James D. Rossen, MDa,
- Marwan Saad, MD, PhDc,d,
- Sidakpal Panaich, MDa,
- Samir Kapadia, MDb and
- Mary Vaughan Sarrazin, PhDa,e
- aDivision of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- bHeart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- cCardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- dDepartment of Cardiology, Ain Shams University, Cairo, Egypt
- eComprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, Iowa City, Iowa
- ↵∗Address for correspondence:
Dr. Amgad Mentias, University of Iowa, 200 Hawkins Drive, E315 GH, Iowa City, Iowa 52242.
Objectives This study sought to evaluate the incidence and outcomes of endocarditis after transcatheter aortic valve replacement (TAVR).
Background Data about endocarditis after TAVR are limited.
Methods The study investigated Medicare patients who underwent TAVR from 2012 to 2017 and identified patients admitted with endocarditis during follow-up using a validated algorithm. The main study outcome was all-cause mortality.
Results Of 134,717 patients who underwent TAVR, 1868 patients developed endocarditis during follow-up (incidence 0.87%/year), with majority of infections (65.0%) occurring within 1 year. Incidence of endocarditis declined in recent years. The most common organisms were Staphylococcus (22.0%), Streptococcus (20.0%), and Enterococcus (15.5%). Important predictors for endocarditis were younger age at TAVR, male sex, prior endocarditis, end-stage renal disease, repeat TAVR procedures, liver and lung disease, and post-TAVR acute kidney injury. Thirty-day and 1-year mortality were 18.5% and 45.6%, respectively. After adjusting for comorbidities and procedural complications, endocarditis after TAVR was associated with 3-fold higher risk of mortality (44.9 vs. 16.2 deaths per 100 person-years; adjusted hazard ratio [aHR]: 2.94; 95% confidence interval [CI]: 2.77 to 3.12; p < 0.0001). End-stage renal disease (aHR: 2.12; 95% CI: 1.72 to 2.60), endocarditis complicated by cardiogenic shock (aHR: 2.50, 95% CI: 1.56 to 4.02), ischemic stroke (aHR: 1.56; 95% CI: 1.07 to 2.28), intracerebral hemorrhage (aHR: 1.67; 95% CI: 1.01 to 2.76), acute kidney injury (aHR: 1.44; 95% CI: 1.27 to 1.63), blood transfusion (aHR: 1.28; 95% CI: 1.09 to 1.50), staphylococcal (aHR: 1.71; 95% CI: 1.49 to 1.97), and fungal endocarditis (aHR: 1.72; 95% CI: 1.23 to 2.39) (p < 0.05 for all) portended higher mortality following endocarditis.
Conclusions The incidence of endocarditis after TAVR is low and declining. However, it is associated with poor prognosis with one-half the patients dying within 1 year.
Dr. Mentias has received support from National Institutes of Health National Research Service Award institutional grant T32 HL007121 to the Abboud Cardiovascular Research Center. Dr. Sarrazin is supported by funding from the National Institute on Aging (R01AG055663-01) and by the Health Services Research and Development Service of the Department of Veterans Affairs. Dr. Horwitz has received grant support from Edwards Lifesciences and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received February 25, 2020.
- Revision received May 4, 2020.
- Accepted May 5, 2020.
- 2020 American College of Cardiology Foundation
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