Author + information
- Received March 18, 2020
- Revision received April 29, 2020
- Accepted May 5, 2020
- Published online September 7, 2020.
- Sandra Santos-Martínez, MDa,b@drassantos,
- Abdullah Alkhodair, MDc,
- Luis Nombela-Franco, MD, PhDd,
- Francesco Saia, MDe,
- Antonio J. Muñoz-García, MD, PhDf,
- Enrique Gutiérrez, MD, PhDg,
- Ander Regueiro, MD, PhDh,
- Victor A. Jimenez-Diaz, MD, PhDi,
- Fernando Rivero, MD, PhDj,
- Rafael Romaguera, MDk,
- Javier Gómez-Herrero, MDa,
- Tania Rodriguez-Gabella, MDa,b,
- Janarthanan Sathananthan, MDc,
- Itziar Gómez Salvador, MScb,
- Manuel Carrasco-Moraleja, MScb,
- Josep Rodés-Cabau, MD, PhDl,
- John Webb, MD, PhDc,
- Javier López, MD, PhDa,b,
- J. Alberto San Román, MD, PhDa,b and
- Ignacio J. Amat-Santos, MD, PhDa,b,∗ (, )@ignamatsant
- aCardiology Department, Hospital Clínico Universitario, Valladolid, Spain
- bCardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
- cSt. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- dCardiology Department, Hospital Clínico San Carlos, Madrid, Spain
- eDivision of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy
- fCIBERCV, Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain
- gCIBERCV, Cardiology Department, Hospital Gregorio Marañón, Madrid, Spain
- hInstitut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- iCIBERCV, Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain
- jCardiology Department, Hospital La Princesa, Madrid, Spain
- kCardiology Department, Hospital Universitari de Bellvitge - IDIBELL, Universitat de Barcelona. Barcelona, Spain
- lQuebec Heart & Lung Institute, Quebec City, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Ignacio J. Amat Santos, Cardiology Department, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Av. Ramón y Cajal, 3, 47005 Valladolid, Spain.
Objectives This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment.
Background Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended.
Methods This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs).
Results Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure.
Conclusions TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.
This project was funded by the Instituto de Salud Carlos III (Madrid, Spain) (PI17/02237). Dr. Saia has received speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific. Dr. Regueiro has been a proctor for Abbott. Dr. Romaguera is a proctor for Boston Scientific. Dr. Sathananthan has received consultant and speaker fees from Edwards Lifesciences and Medtronic. Dr. Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Webb has received research funding from Edwards Lifesciences. 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 March 18, 2020.
- Revision received April 29, 2020.
- Accepted May 5, 2020.
- 2020 American College of Cardiology Foundation
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