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09-03-2022 | Aortic Valve Replacement | Original Paper

Very early infective endocarditis after transcatheter aortic valve replacement

Authors: Vassili Panagides, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Piotr Scislo, Zenon Huczek, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca Testa, Won-Keun Kim, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Philippe Gervais, David del Val, Axel Linke, Lisa Crusius, Holger Thiele, David Holzhey, Josep Rodés-Cabau

Published in: Clinical Research in Cardiology | Issue 10/2022

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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Title: Very early infective endocarditis after transcatheter aortic valve replacement
Authors: Vassili Panagides
Mohamed Abdel-Wahab
Norman Mangner
Eric Durand
Nikolaj Ihlemann
Marina Urena
Costanza Pellegrini
Francesco Giannini
Piotr Scislo
Zenon Huczek
Martin Landt
Vincent Auffret
Jan Malte Sinning
Asim N. Cheema
Luis Nombela-Franco
Chekrallah Chamandi
Francisco Campelo-Parada
Erika Munoz-Garcia
Howard C. Herrmann
Luca Testa
Won-Keun Kim
Helene Eltchaninoff
Lars Søndergaard
Dominique Himbert
Oliver Husser
Azeem Latib
Hervé Le Breton
Clement Servoz
Philippe Gervais
David del Val
Axel Linke
Lisa Crusius
Holger Thiele
David Holzhey
Josep Rodés-Cabau
Publication date: 09-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Aortic Valve Replacement
Heart Surgery
Antibiotic
Heart Surgery
Endocarditis
Aortic Valve Replacement
Aortic Valve Replacement
Published in: Clinical Research in Cardiology / Issue 10/2022
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-022-01998-0

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Very early infective endocarditis after transcatheter aortic valve replacement

Abstract

Background

Objective

Methods

Results

Conclusion

Graphical abstract

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Abstract

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Graphical abstract

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