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Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
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102
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Infective endocarditis post-transcatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review. PLoS One 2020; 15:e0225077. [PMID: 31951610 PMCID: PMC6968844 DOI: 10.1371/journal.pone.0225077] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. METHODS EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. RESULTS The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. CONCLUSION The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. STUDY REGISTRATION PROSPERO registration number CRD42018115943.
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103
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Harding D, Cahill TJ, Redwood SR, Prendergast BD. Infective endocarditis complicating transcatheter aortic valve implantation. Heart 2020; 106:493-498. [DOI: 10.1136/heartjnl-2019-315338] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/03/2022] Open
Abstract
Infective endocarditis complicating transcatheter aortic valve implantation (TAVI-IE) is a relatively rare condition with an incidence of 0.2%–3.1% at 1 year post implant. It is frequently caused by Enterococci, Staphylococcus aureus and coagulase negative staphylococci. While the incidence currently appears to be falling, the absolute number of cases is likely to rise substantially as TAVI expands into low risk populations following the publication of the PARTNER 3 and Evolut Low Risk trials. Important risk factors for the development of TAVI-IE include a younger age at implant and significant residual aortic regurgitation. The echocardiographic diagnosis of TAVI-IE can be challenging, and the role of supplementary imaging techniques including multislice computed tomography (MSCT) and positron emission tomography (18FDG PET) is still emerging. Treatment largely parallels that of conventional prosthetic valve endocarditis (PVE), with prolonged intravenous antibiotic therapy and consideration of surgical intervention forming the cornerstones of management. The precise role and timing of cardiac surgery in TAVI-IE is yet to be defined, with a lack of clear evidence to help identify which patients should be offered surgical intervention. Minimising unnecessary healthcare interventions (both during and after TAVI) and utilising appropriate antibiotic prophylaxis may have a role in preventing TAVI-IE, but robust evidence for specific preventative strategies is lacking. Further research is required to better select patients for advanced hybrid imaging, to guide surgical management and to inform prevention in this challenging patient cohort.
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104
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Vendramin I, Benedetti G, Lechiancole A, Sponga S, Meneguzzi M, Auci E, Bortolotti U, Livi U. Infective endocarditis following a valve-in-valve procedure. Gen Thorac Cardiovasc Surg 2020; 68:1469-1471. [DOI: 10.1007/s11748-019-01285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
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105
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Valvo R, Criscione E, Reddavid C, Barbanti M. Early detection of transcatheter heart valve dysfunction. Expert Rev Cardiovasc Ther 2019; 17:863-872. [PMID: 31829050 DOI: 10.1080/14779072.2019.1703673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter aortic valve implantation therapy is spreading rapidly, representing the standard of care in inoperable and high-risk patients, and a valid alternative in intermediate- and low-risk patients with severe symptomatic aortic stenosis. In this subset, the development and validation of noninvasive, quantitative, in vivo imaging modality, to monitor possible valve dysfunction is mandatory, in order to plan timely therapeutic interventions before the onset of symptoms.Areas covered: The implantation of transcatheter heart valves (THV) is increasing rapidly. As a consequence, THV dysfunction will become a major cause of cardiovascular morbidity after TAVI. Emergency repeat aortic valve replacement surgery is associated with a high rate of mortality compared with elective repeat surgery. In this context, early detection of THV dysfunction is therefore highly desirable. The review aims to examine the different diagnostic method to early detect THV dysfunction.Expert opinion: Most promising innovations in the diagnosis of early detection of THV dysfunction are evaluated, and the future outlook is explored. Waiting for upcoming evidence about the utility of CT, CMR, and PET on early detection of THV dysfunction, tailoring echocardiogram follow-up based on patients' characteristics is the desirable approach.
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Affiliation(s)
- Roberto Valvo
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Enrico Criscione
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Claudia Reddavid
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Marco Barbanti
- A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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106
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Li YM, Mei FY, Yao YJ, Tsauo JY, Peng Y, Chen M. Causes and predictors of readmission after transcatheter aortic valve implantation : A meta-analysis and systematic review. Herz 2019; 46:1-8. [PMID: 31807789 DOI: 10.1007/s00059-019-04870-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Since readmission rate is an important clinical index to determine the quality of inpatient care and hospital performance, the aim of this study was to explain the causes and predictors of readmission following transcatheter aortic valve implantation (TAVI) at short-term and mid-term follow-up. METHODS AND RESULTS A systematic review and meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and Ovid was carried out. In all, 10 studies including 52,702 patients were identified. The pooled estimate for the overall event rate was 0.15, and cardiovascular causes were the main reason for 30-day readmission (0.42, 95% confidence interval [CI]: 0.39-0.45). In addition, the pooled incidence of 1‑year readmission was 0.31, and cardiovascular events were still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and life-threatening bleeding, new permanent pacemaker implantation, and clinical heart failure were associated with a high risk for early readmission after TAVI. Moreover, an advanced (≥3) New York Heart Association classification, acute kidney injury, paravalvular leak, mitral regurgitation (≥ moderate), and major bleeding predicted unfavorable outcome to 1‑year readmission. Female gender and transfemoral TAVI was associated with a lower risk for unplanned rehospitalization. CONCLUSIONS This meta-analysis found cardiovascular factors to be the main causes for both 30-day and 1‑year rehospitalization. Heart failure represented the most common cardiovascular event at both short-term and mid-term follow-up. Several baseline characteristics and procedure-related factors were deemed unfavorable predictors of readmission. Importantly, transfemoral access and female gender were associated with a lower risk of readmission.
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Affiliation(s)
- Yi-Ming Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Fu-Yang Mei
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yi-Jun Yao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jia-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China.
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107
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Schrimpf C, Ziesing S, Michelmann P, Rustum S, Teebken OE, Haverich A, Wilhelmi M. Conventional culture diagnostics vs. multiplex PCR for the detection of causative agents of vascular graft infections - results of a single centre observational pilot study. VASA 2019; 49:43-49. [PMID: 31755826 DOI: 10.1024/0301-1526/a000827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Timely diagnosis of vascular graft infections is of major importance in vascular surgery. The detection of causative microorganisms is needed for specific medical treatment, but conventional culture is often slow, insensitive and inconclusive due to antibiotic pre-treatment. Detection of bacterial DNA by polymerase chain reaction (PCR) might bypass these problems. We hypothesised that multiplex PCR (mPCR) is feasible, fast and sensitive to detect causative microorganisms in vascular graft infections. Patients and methods: We performed a pilot observational prospective study comparing conventional culture and a commercial mPCR. Inclusion criteria were: confirmed graft infection, suspicious imaging, clinical suspicion, anastomotic aneurysm and repeated graft occlusion. Diagnostic methods were performed using identical samples. Time to result, microorganisms and antibiotic resistance in both groups were compared using Student's t-test or nonparametric tests. Results: 22 samples from 13 patients were assessed and 11 samples were negative for bacteria. Some showed multiple germs. In total, we found 15 different organisms. 13 samples matched, 9 had non-concordant results. Out of the mismatches 3 microorganisms identified in PCR were not detected by culture. Time to result with PCR was shorter (median 5 h vs. 72 h, p < 0.001) than with culture. No resistance genes were detected by mPCR, but conventional culture allowed susceptibility testing and revealed resistance in 5 samples. Conclusions: mPCR seems to be a feasible and quick tool to detect causes of vascular graft infections within 24 h and might be helpful in antibiotic pre-treated patients. The detection of antibiotic resistance with mPCR needs improvement for clinical practice.
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108
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Rescue Aortic Root Replacement for Endocarditis After Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 109:1948-1949. [PMID: 31765621 DOI: 10.1016/j.athoracsur.2019.09.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022]
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109
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Abstract
Initially, transcatheter aortic valve replacement (TAVR) was only used in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement. Subsequently, TAVR was extended to patients with high and intermediate surgical risk. Recently, the results of randomized trials in low-surgical-risk patients showed superiority or noninferiority of TAVR versus surgical aortic valve replacement in this population. Procedural outcomes have been improved. Long-term durability of transcatheter heart valves remains to be confirmed. This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes.
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110
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Lam DH, Itani M, Dvir D. Evaluation of failed prosthetic valves in the valve-in-valve era: Potential for utilizing positron emission tomography/computed tomography to recognize infective endocarditis. Catheter Cardiovasc Interv 2019; 94:863-869. [PMID: 30856285 DOI: 10.1002/ccd.28185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/06/2022]
Abstract
Bioprosthetic valve dysfunction was treated in the past with redo open heart surgery. The need to identify occult leaflet infection was not an important requirement as all valve tissue was removed during surgery. With the dramatic growth in transcatheter aortic valve replacement (TAVR) valve-in-valve (ViV) therapy, identification of occult infection is of major significance. TAVR should be rarely performed in infected prosthetic valves and the optimal approach should include open heart surgery and removal of infected tissue. With surgical implants, it can be challenging to distinguish infection from degeneration. The use of advanced imaging modalities, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography, in the diagnosis of occult infection is emerging. We report the use of this imaging modality to identify or exclude endocarditis in patients with prosthetic valves who were candidates for ViV therapy.
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Affiliation(s)
- David H Lam
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Malak Itani
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Washington
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111
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Regueiro A, Linke A, Latib A, Ihlemann N, Urena M, Walther T, Husser O, Herrmann H, Nombela-Franco L, Cheema A, Le Breton H, Stortecky S, Kapadia S, Bartorelli A, Sinning JM, Amat-Santos I, Munoz-Garcia A, Lerakis S, Gutíerrez-Ibanes E, Abdel-Wahab M, Tchetche D, Testa L, Eltchaninoff H, Livi U, Castillo JC, Jilaihawi H, Webb J, Barbanti M, Kodali S, de Brito Jr F, Ribeiro H, Miceli A, Fiorina C, Actis Dato GM, Rosato F, Serra V, Masson JB, Wijeysundera H, Mangione J, Ferreira MC, Lima V, Carvalho L, Abizaid A, Marino M, Esteves V, Andrea J, Messika-Zeitoun D, Himbert D, Kim WK, Pellegrini C, Auffret V, Nietlispach F, Pilgrim T, Durand E, Lisko J, Makkar R, Lemos P, Leon M, Puri R, San Roman A, Vahanian A, Søndergaard L, Mangner N, Rodés-Cabau J. Infective Endocarditis Following Transcatheter Aortic Valve Replacement: Comparison of Balloon- Versus Self-Expandable Valves. Circ Cardiovasc Interv 2019; 12:e007938. [PMID: 31694412 DOI: 10.1161/circinterventions.119.007938] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. METHODS Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. RESULTS A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2-15] months versus BEV, 5.3 [1.7-11.4] months; P=0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P<0.01), and vegetation location differed according to valve type (stent frame, SEV, 18.6%; BEV, 6.9%; P=0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P=0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04-5.82, P=0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P=0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P=0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died (P=0.66). CONCLUSIONS The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field.
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Affiliation(s)
- Ander Regueiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Germany
| | - Azeem Latib
- Interventional Cardiology Unit, Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Asim Cheema
- Division of Cardiology, St. Michaels Hospital, Toronto,
Canada
| | | | - Stefan Stortecky
- Bern University Hospital (on behalf of Swiss Registry Centres), Switzerland
| | | | | | | | | | - Antonio Munoz-Garcia
- Department of Cardiology, Hospital Universitario Virgen de
la Victoria, Malaga, Spain
| | | | - Enrique Gutíerrez-Ibanes
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon, Hospital Gregorio Maranon, Madrid, Spain
| | | | | | | | | | - Ugolino Livi
- AOU Santa Maria della Misericordia, Udine, Italy
| | | | | | - John Webb
- Center for Heart Valve Innovation, St. Pauls Hospital, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valter Lima
- Hospital Sao FranciscoSanta Clara, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Thomas Pilgrim
- Bern University Hospital (on behalf of Swiss Registry Centres), Switzerland
| | - Eric Durand
- Hôpital Charles Nicolle, University of Rouen, France
| | - John Lisko
- Emory University School of Medicine, Atlanta
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles
| | - Pedro Lemos
- Instituto Nacional Cardiovascular (INCOR), Sao Paulo, Brazil
| | - Martin Leon
- Columbia University Medical Center, New York
| | - Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
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112
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Summers MR, Leon MB, Smith CR, Kodali SK, Thourani VH, Herrmann HC, Makkar RR, Pibarot P, Webb JG, Leipsic J, Alu MC, Crowley A, Hahn RT, Kapadia SR, Tuzcu EM, Svensson L, Cremer PC, Jaber WA. Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials. Circulation 2019; 140:1984-1994. [PMID: 31690104 DOI: 10.1161/circulationaha.119.041399] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prosthetic valve endocarditis (PVE) is a rare but critical mechanism of valve failure and death after transcatheter and surgical aortic valve replacement (TAVR, SAVR) warranting further analysis in modern aortic valve replacement experience. We characterize the incidence, risk factors, microbiological profile and outcomes of PVE from the PARTNER trials and registries (Placement of Aortic Transcatheter Valve). METHODS We analyzed a pooled cohort of all patients in PARTNER 1 and PARTNER 2 trials and registries. Patients had severe aortic stenosis, were treated with TAVR or SAVR, and were analyzed with respect to development of PVE. PVE adjudication by a clinical events committee was based on modified Duke Criteria. The incidence, infection timing, organism, and association between PVE and all-cause mortality were analyzed. RESULTS 8530 patients were included. PVE occurred in 107 cases (5.06 PVE events per 1000 person-years over a mean follow-up of 2.69±1.55 years [95% CI, 4.19-6.12]). The incidence of TAVR-PVE (5.21 PVE per 1000 person-years [95% CI, 4.26-6.38]) was not significantly different from SAVR-PVE (4.10 per 1000 person-years [95% CI, 2.33-7.22]; incident rate ratio, 1.27 [95% CI, 0.70-2.32]; P=0.44). Temporal risk of PVE was similar for TAVR and SAVR, even after adjusting for competing risk of death (hazard ratio, 1.15 [95% CI, 0.58-2.28]; P=0.69). Through multivariable analysis, PVE was associated with baseline cirrhosis (incident rate ratio, 2.86 [95% CI, 1.33-6.16]; P=0.007), pulmonary disease (incident rate ratio, 1.70 [95% CI, 1.16-2.48]; P=0.006), and renal insufficiency (incident rate ratio, 1.71 [95% CI, 1.03-2.83]; P=0.04). Timing of PVE was similar between TAVR and SAVR (<30 days: 4.2% vs 8.3%; 31 days to 1 year: 52.6% vs 66.7%; >1 year: 43.2% vs 25.0%; P=0.28). Staphylococcus occurred more commonly after SAVR (58.3% vs 28.4% in TAVR; P=0.04). PVE was strongly associated with all-cause mortality after endocarditis diagnosis (hazard ratio, 4.4 [95% CI, 3.42-5.72]; P<0.0001). CONCLUSIONS The widespread adoption of TAVR and application to lower-risk patients makes understanding mechanisms of valve failure increasingly important. PVE is an established mechanism of prosthetic valve failure post-SAVR and TAVR with unclear differences between approaches. We herein demonstrate in the largest trials and registries of TAVR that PVE remains rare, but often fatal, in modern AVR experience and that there is no difference in incidence, predictors, or risk of PVE between TAVR and SAVR. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique identifiers: NCT00530894 (PARTNER 1), NCT01314313 (PARTNER 1IA), NCT02184442 (PARTNER 1IB), NCT03222141 (PII S3HR), NCT03222128 (PII S3i).
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Affiliation(s)
- Matthew R Summers
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
| | - Martin B Leon
- Columbia University/New York-Presbyterian Hospital, NY (M.B.L., C.R.S., S.K.K., M.C.A., R.T.H.)
| | - Craig R Smith
- Columbia University/New York-Presbyterian Hospital, NY (M.B.L., C.R.S., S.K.K., M.C.A., R.T.H.)
| | - Susheel K Kodali
- Columbia University/New York-Presbyterian Hospital, NY (M.B.L., C.R.S., S.K.K., M.C.A., R.T.H.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | | | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.R.M.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Canada (P.P.)
| | - John G Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, Canada (J.G.W., J.L.)
| | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, Canada (J.G.W., J.L.)
| | - Maria C Alu
- Columbia University/New York-Presbyterian Hospital, NY (M.B.L., C.R.S., S.K.K., M.C.A., R.T.H.).,Cardiovascular Research Foundation, New York, NY (M.C.A., A.C.)
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY (M.C.A., A.C.)
| | - Rebecca T Hahn
- Columbia University/New York-Presbyterian Hospital, NY (M.B.L., C.R.S., S.K.K., M.C.A., R.T.H.)
| | - Samir R Kapadia
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
| | - E Murat Tuzcu
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
| | - Lars Svensson
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
| | - Paul C Cremer
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
| | - Wael A Jaber
- Cleveland Clinic Foundation, OH (M.R.S., S.R.K., E.M.T., L.S., P.C.C., W.A.J.)
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113
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Ten things ICU specialists need to know about new valvular procedures in interventional cardiology. Intensive Care Med 2019; 46:102-106. [PMID: 31686127 DOI: 10.1007/s00134-019-05824-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 12/28/2022]
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114
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Carasso S, Amy DPB, Kusniec F, Ghanim D, Sudarsky D, Kinany W, Shmuel C, Abu El-Naaj I, Kachel E, Amir O. Dental screening prior to valve interventions: Should we prepare transcatheter aortic valve replacement candidates for "surgery"? Int J Cardiol 2019; 294:23-26. [PMID: 31378381 DOI: 10.1016/j.ijcard.2019.07.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/01/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND 40% of cases of infective endocarditis (IE) are likely caused by oral bacteria. IE prevalence after transcatheter aortic valve replacement (TAVR) is comparable to IE following surgical prosthetic valve replacement (SVR). Current guidelines recommend pre-operative dental screening for SVR, without specific recommendations regarding TAVR. We aimed to compare oral dental findings in TAVR vs. surgical valve replacement (SVR) candidates and assess the need for routine dental screening and treatment prior to TAVR similar to the SVR patients. METHODS 150 patients (58 TAVR candidates and 92 surgical candidates) were all referred for screening and appropriate treatment before intervention to our Oral medicine team, blinded to the planned interventional type. All patients were scored for oral hygiene and dental findings that required intervention. An oral health score (OHS, general hygiene: 0-good, 1-bad, need for immediate treatment: 0-no, 1-yes, need for future treatment: 0-no, 1-yes) was calculated and compared. Patients were clinically followed for IE for 14 ± 5 months (rage 8-28) post intervention. RESULTS While candidates for SVR were younger than TAVR (66 + 10 vs. 81 ± 6 respectively, P < 0.0001), oral-dental findings were similar. OHS was 1.6 for SVR and 1.7 for TAVR candidates, p = 0.45). Half of patients in either group had findings requiring pre-procedural dental treatment. There were two IE cases during follow-up, one in each group. CONCLUSION Oral health and need for pre-procedural dental treatment were not different among candidates for SVR and TAVR. IE preventive oral-dental care seems to be justified in patients undergoing TAVR initially denied SVR due to prohibitive operative risk.
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Affiliation(s)
- Shemy Carasso
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
| | - Dalit Porat Ben Amy
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Doron Sudarsky
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Wadi Kinany
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Chen Shmuel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Imad Abu El-Naaj
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Oral and Cranio-maxillofacial surgery Department, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel
| | - Erez Kachel
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Offer Amir
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee 15208, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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Sugimura Y, Katahira S, Lopez Lopez R, Rellecke P, Lichtenberg A, Akhyari P. Surgical aortic valve replacement due to infective endocarditis after transcatheter aortic valve implantation with the self-expanding Portico valve prosthesis. Ann Cardiothorac Surg 2019; 8:699-701. [PMID: 31832365 DOI: 10.21037/acs.2019.05.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Shintaro Katahira
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Rene Lopez Lopez
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Di Domenico EG, Rimoldi SG, Cavallo I, D’Agosto G, Trento E, Cagnoni G, Palazzin A, Pagani C, Romeri F, De Vecchi E, Schiavini M, Secchi D, Antona C, Rizzardini G, Dichirico RB, Toma L, Kovacs D, Cardinali G, Gallo MT, Gismondo MR, Ensoli F. Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis. BMC Microbiol 2019; 19:228. [PMID: 31638894 PMCID: PMC6802308 DOI: 10.1186/s12866-019-1596-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is associated with high rates of mortality. Prolonged treatments with high-dose intravenous antibiotics often fail to eradicate the infection, frequently leading to high-risk surgical intervention. By providing a mechanism of antibiotic tolerance, which escapes conventional antibiotic susceptibility profiling, microbial biofilm represents a key diagnostic and therapeutic challenge for clinicians. This study aims at assessing a rapid biofilm identification assay and a targeted antimicrobial susceptibility profile of biofilm-growing bacteria in patients with IE, which were unresponsive to antibiotic therapy. RESULTS Staphylococcus aureus was the most common isolate (50%), followed by Enterococcus faecalis (25%) and Streptococcus gallolyticus (25%). All microbial isolates were found to be capable of producing large, structured biofilms in vitro. As expected, antibiotic treatment either administered on the basis of antibiogram or chosen empirically among those considered first-line antibiotics for IE, including ceftriaxone, daptomycin, tigecycline and vancomycin, was not effective at eradicating biofilm-growing bacteria. Conversely, antimicrobial susceptibility profile of biofilm-growing bacteria indicated that teicoplanin, oxacillin and fusidic acid were most effective against S. aureus biofilm, while ampicillin was the most active against S. gallolyticus and E. faecalis biofilm, respectively. CONCLUSIONS This study indicates that biofilm-producing bacteria, from surgically treated IE, display a high tolerance to antibiotics, which is undetected by conventional antibiograms. The rapid identification and antimicrobial tolerance profiling of biofilm-growing bacteria in IE can provide key information for both antimicrobial therapy and prevention strategies.
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Affiliation(s)
- Enea Gino Di Domenico
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Sara Giordana Rimoldi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Ilaria Cavallo
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giovanna D’Agosto
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Elisabetta Trento
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giovanni Cagnoni
- UOC Cardiochirurgia, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Alessandro Palazzin
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Cristina Pagani
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Francesca Romeri
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Orthopedic Institute Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Monica Schiavini
- Dipartimento di Malattie Infettive, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Daniela Secchi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Carlo Antona
- UOC Cardiochirurgia, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Giuliano Rizzardini
- Dipartimento di Malattie Infettive, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Rita Barbara Dichirico
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, Regina Elena National Cancer Institute IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology Lab, San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Giorgia Cardinali
- Cutaneous Physiopathology Lab, San Gallicano Dermatologic Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Maria Teresa Gallo
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
| | - Maria Rita Gismondo
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Polo Universitario, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Fabrizio Ensoli
- Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), via Elio Chianesi, 53 00144 Rome, Italy
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Hitzenbichler F, Olic J, Hanses F, Salzberger B, Fischer M, Baessler A. [Current treatment of endocarditis : Innovations and controversies]. Internist (Berl) 2019; 60:1111-1117. [PMID: 31444523 DOI: 10.1007/s00108-019-00664-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.
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Affiliation(s)
- F Hitzenbichler
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - J Olic
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - F Hanses
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M Fischer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - A Baessler
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Cotti E, Cairo F, Bassareo P, Fonzar F, Venturi M, Landi L, Parolari A, Franco V, Fabiani C, Barili F, Di Lenarda A, Gulizia M, Borzi M, Campus G, Musumeci F, Mercuro G. Perioperative dental screening and treatment in patients undergoing cardio-thoracic surgery and interventional cardiovascular procedures. A consensus report based on RAND/UCLA methodology. Int J Cardiol 2019; 292:78-86. [DOI: 10.1016/j.ijcard.2019.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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119
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Olsthoorn JR, Lam K, Verberkmoes NJ. Endocarditis after transcatheter aortic valve replacement; a new nightmare in cardiac surgery. J Card Surg 2019; 34:1420-1421. [PMID: 31523842 DOI: 10.1111/jocs.14257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatment of prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR) remains challenging. An increase in TAVR endocarditis is inevitable, especially with the extension of indications and implantation in low-risk patients. We present a case of complex surgical treatment of prosthetic valve endocarditis after TAVR.
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Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Kayan Lam
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Niels J Verberkmoes
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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McElhinney DB, Sondergaard L, Armstrong AK, Bergersen L, Padera RF, Balzer DT, Lung TH, Berger F, Zahn EM, Gray RG, Hellenbrand WE, Kreutzer J, Eicken A, Jones TK, Ewert P. Endocarditis After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2019; 72:2717-2728. [PMID: 30497557 DOI: 10.1016/j.jacc.2018.09.039] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and prosthetic valves. OBJECTIVES The aim of this study was to evaluate rates and potential risk factors for endocarditis after transcatheter pulmonary valve replacement in the prospective Melody valve trials. METHODS All patients in whom a transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3 prospective multicenter studies comprised the analytic cohort. The diagnosis of endocarditis and involvement of the TPV were determined by the implanting investigator. RESULTS A total of 309 patients underwent transcatheter pulmonary valve replacement (TPVR) and were discharged with a valve in place. The median follow-up duration was 5.1 years, and total observation until study exit was 1,660.3 patient-years. Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR), and a total of 35 patients were reported to have TPV-related endocarditis (34 at the initial diagnosis, 1 with a second episode). The annualized incidence rate of endocarditis was 3.1% per patient-year and of TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR, freedom from a diagnosis of endocarditis was 89% and freedom from TPV-related endocarditis was 92%. By multivariable analysis, age ≤12 years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4; p = 0.011) and immediate post-implant peak gradient ≥15 mm Hg (2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002) were associated with development of endocarditis and with development of TPV-related endocarditis (age ≤12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p = 0.006; gradient ≥15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p = 0.008). CONCLUSIONS Endocarditis is an important adverse outcome following TVPR in children and adults with post-operative congenital heart disease involving the RVOT. Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study: Post Approval Study of the Original Investigational Device Exemption [IDE] Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV] Post-Market Surveillance Study; NCT00688571).
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Affiliation(s)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Robert F Padera
- Brigham and Women's Hospital, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Evan M Zahn
- Cedars-Sinai Heart Institute, Los Angeles, California
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121
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Shirakawa K, Murata M. Significance of echocardiographic evaluation for transcatheter aortic valve implantation. Cardiovasc Interv Ther 2019; 35:85-95. [PMID: 31502235 DOI: 10.1007/s12928-019-00617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is widely accepted as an alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS). Existing scientific evidence demonstrates that TAVI is superior to SAVR, and it is expected that indications for the clinical applications of TAVI will be expanded in the future. Echocardiography plays a key role in perioperative assessment of patients undergoing TAVI. Preprocedural echocardiographic evaluation is important to determine the severity of AS in addition to patients' anatomical suitability for TAVI. Furthermore, echocardiography is essential for intraoperative guidance, assessment of complications, postoperative evaluation, and prognostic prediction. Inaccurate echocardiographic measurements and evaluation can lead to less-than-optimal/inappropriate treatment strategies in patients with AS. Therefore, a thorough understanding of the limitations of echocardiographic evaluation is important. This review summarizes the role of echocardiographic evaluation in patients undergoing TAVI.
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Affiliation(s)
- Kohsuke Shirakawa
- Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,School of Medicine, Center for Preventive Medicine, Keio University, Tokyo, Japan.
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Montero-Cruces L, Luque-Díaz TS, Ramchandani-Ramchandani B, Carnero-Alcázar M, Maroto-Castellanos LC. Endocarditis protésica precoz tras implante de prótesis valvular aórtica transcatéter por vía transfemoral. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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124
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Bax JJ, Delgado V. Prosthetic valve endocarditis after surgical and transcatheter aortic valve replacement: infrequent, but poor outcome. EUROINTERVENTION 2019; 15:e484-e485. [PMID: 31395575 DOI: 10.4244/eijv15i6a88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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125
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Moriyama N, Laakso T, Biancari F, Raivio P, Jalava MP, Jaakkola J, Dahlbacka S, Kinnunen EM, Juvonen T, Husso A, Niemelä M, Ahvenvaara T, Tauriainen T, Virtanen M, Maaranen P, Eskola M, Rosato S, Mäkikallio T, Savontaus M, Valtola A, Anttila V, Airaksinen J, Laine M. Prosthetic valve endocarditis after transcatheter or surgical aortic valve replacement with a bioprosthesis: results from the FinnValve Registry. EUROINTERVENTION 2019; 15:e500-e507. [PMID: 31113766 DOI: 10.4244/eij-d-19-00247] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the risk of prosthetic valve endocarditis (PVE) in patients with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). METHODS AND RESULTS The FinnValve registry included data from 6,463 consecutive patients who underwent TAVR (n=2,130) or SAVR (n=4,333) with a bioprosthesis from 2008 to 2017. PVE was defined according to the modified Duke criteria. In this study, the incidence of PVE was 3.4/1,000 person-years after TAVR, and 2.9/1,000 person-years after SAVR. In competing risk analysis there was no significant difference in the risk of PVE between patients with TAVR and SAVR over an eight-year observational period. Male gender (HR 1.73, 95% CI: 1.04-2.89) and deep sternal wound infection or vascular access-site infection (HR 5.45, 95% CI: 2.24-13.2) were positively associated with PVE, but not type of procedure (HR 1.09, 95% CI: 0.59-2.01) in multivariate analysis. The mortality rate was 37.7% at one month and increased to 52.5% at one year. Surgical treatment was independently associated with decreased in-hospital mortality (HR 0.34, 95% CI: 0.21-0.61). CONCLUSIONS PVE is rare, and its risk is similar after TAVR and SAVR. ClinicalTrials.gov Identifier: NCT03385915. https://clinicaltrials.gov/ct2/show/NCT03385915.
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Affiliation(s)
- Noriaki Moriyama
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Right Anterior Minithoracotomy for Endocarditis After Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 109:e17-e19. [PMID: 31233720 DOI: 10.1016/j.athoracsur.2019.04.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become an equivalent alternative to surgical aortic valve replacement also in patients at low surgical risk. Prosthetic valve endocarditis after TAVR (TAVR-PVE) is a dangerous complication with the highest mortality rate among endocarditis patients. Only a minority of patients receive surgical treatment of TAVR-PVE. We present a case of surgical treatment of TAVR-PVE in a 75-year-old patient. The success of the treatment is based on the reduction of the operative trauma and length of the procedure with the use of minimally invasive right-sided thoracotomy and the Perceval sutureless aortic valve prosthesis (LivaNova, London, United Kingdom).
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Gürtler N, Osthoff M, Rueter F, Wüthrich D, Zimmerli L, Egli A, Bassetti S. Prosthetic valve endocarditis caused by Pseudomonas aeruginosa with variable antibacterial resistance profiles: a diagnostic challenge. BMC Infect Dis 2019; 19:530. [PMID: 31208366 PMCID: PMC6580457 DOI: 10.1186/s12879-019-4164-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background Infective endocarditis (IE) caused by gram-negative bacilli is rare. However, the incidence of this severe infection is rising because of the increasing number of persons at risk, such as patients with immunosuppression or with cardiac implantable devices and prosthetic valves. The diagnosis of IE is often difficult, particularly when microorganisms such as Pseudomonas aeruginosa, which rarely cause this infection, are involved. One of the mainstays for the diagnosis of IE are persistently positive blood cultures with the same bacteria, while polymicrobial bacteremia usually points to another cause, e.g. an abscess. The antimicrobial resistance profile of some P. aeruginosa strains may change, falsely suggesting an infection with several strains, thus further increasing the diagnostic difficulties. Case presentation A 66-year old male patient who had a transcatheter aortic valve implantation (TAVI) one year previously developed fever seven days after an elective inguinal hernia repair. During the following four weeks, P. aeruginosa with different antibiotic resistance profiles was repeatedly isolated from blood cultures. Repeated trans-esophageal echocardiograms (TEE) were negative and an infection by different P. aeruginosa strains was suspected. Extensive diagnostic workup for an infectious focus was performed with no results. Finally, an oscillating mass on the aortic valve was detected by TEE five weeks after the initial positive blood cultures. P. aeruginosa endocarditis was confirmed by culture of the surgically removed valve. Whole genome sequencing of the last two P. aeruginosa isolates (valve and blood culture) revealed identical strains, with genome mutations for AmpR, AmpD and OprD. Conclusions The diagnosis of prosthetic valve endocarditis is particularly difficult for several reasons. The modified Duke criteria have a lower sensitivity for patients with prosthetic valve endocarditis and the infection may be caused by “unusual” pathogens such as P. aeruginosa. Patients with repeatedly positive blood cultures should make clinicians suspicious for endocarditis even if imaging studies are negative and if isolated pathogens are “unusual”. Repeatedly positive blood cultures for P. aeruginosa should be considered as “persistent bacteremia” (suspicious for IE) even in the presence of different antibiotic susceptibility patterns, since P. aeruginosa might rapidly activate or deactivate resistance mechanisms depending on antibiotic exposition.
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Affiliation(s)
- Nicolas Gürtler
- Division of Internal Medicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Michael Osthoff
- Division of Internal Medicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Rueter
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Wüthrich
- Clinical Microbiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine, Kantonsspital Olten, Olten, Switzerland
| | - Adrian Egli
- Clinical Microbiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Cotti E, Cairo F, Bassareo PP, Fonzar F, Venturi M, Landi L, Parolari A, Franco V, Fabiani C, Barili F, Di Lenarda A, Gulizia M, Borzi M, Campus G, Musumeci F, Mercuro G. Perioperative dental screening and treatment in patients undergoing cardiothoracic surgery and interventional cardiovascular procedures. A consensus report based on RAND/UCLA methodology. Int Endod J 2019; 53:186-199. [PMID: 31162683 DOI: 10.1111/iej.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 05/31/2019] [Indexed: 11/28/2022]
Abstract
AIM To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections and on the feasibility of providing dental treatment before cardiothoracic surgery, cardiovascular surgery or other cardiovascular invasive procedures. METHODOLOGY A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, a systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients, had never been defined. Following the systematic review, several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently, and then, a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures. RESULTS A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered. CONCLUSIONS Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus will become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre-interventional preparation phase.
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Affiliation(s)
- E Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - F Cairo
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - P P Bassareo
- University College of Dublin, Mater Misericordiae University Teaching Hospital, Dublin, Ireland
| | | | | | - L Landi
- Private practice, Verona, Roma, Italy
| | - A Parolari
- Unit of Cardiac Surgery and Translational Researh, IRCCS Policlinico S. Donato, San Donato, Italy
| | | | | | - F Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | | | - M Gulizia
- Division of Cardiology, Hospital "Garibaldi-Nesima", Catania, Italy
| | - M Borzi
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
| | - G Campus
- Department of Surgery, Microsurgery and Medicine Sciences, University of Sassari, Sassari, Italy
| | - F Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Roma, Italy
| | - G Mercuro
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
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129
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Delahaye F, De Gevigney G. [Infective endocarditis and specific situations: Right heart, valve prosthesis, cardiac implantable electronic device]. Presse Med 2019; 48:549-555. [PMID: 31109767 DOI: 10.1016/j.lpm.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022] Open
Abstract
Right-sided infective endocarditis (IE) represents 5-10% of IE. It may occur in patients with electronic intracardiac device, central venous catheter or congenital heart disease, but the most frequent situation is intravenous drug use. Prosthetic valve IE is the most severe form of IE. The diagnosis is more challenging than that of native valve IE, as is treatment, both antibiotic treatment and surgical indications. The infection of an electronic intracardiac device is a severe disease. Both diagnostic and therapeutic strategies are difficult.
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Affiliation(s)
- François Delahaye
- Hôpital Louis-Pradel, hospices civils de Lyon, 69677 Lyon, France; Université Claude-Bernard Lyon I, 69008 Lyon, France.
| | - Guy De Gevigney
- Hôpital Louis-Pradel, hospices civils de Lyon, 69677 Lyon, France; Université Claude-Bernard Lyon I, 69008 Lyon, France
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130
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Scisło P, Grodecki K, Wilimski R, Rymuza B, Kochman J, Opolski G, Huczek Z. Different types of endocarditis after transcatheter aortic valve implantation. Echocardiography 2019; 36:1132-1138. [PMID: 31012135 DOI: 10.1111/echo.14346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/30/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) may take different faces in patients after transcatheter aortic valve implantation (TAVI). OBJECTIVES The primary aim of this study was to describe echocardiographic and clinical characteristics of TAVI's patients suffered from IE. METHODS In a single-center, retrospective study we analyzed 311 consecutive patients treated with TAVI for severe aortic stenosis between 2010 and 2018. RESULTS According to modified Duke criteria, we confirmed IE in 2.2% of the cohort, however PVE of TAVI's valve in 1.2% only; rest of the group suffered from CDRiE and IE of the mitral valve. In PVE's group vegetations were localized inside the frame with or without bioprosthesis moderate stenosis or regurgitation. Only 1 pts developed significant TAVI's bioprosthesis' paravalvular leak. We observed no native aortic anulus involvement. Mortality rate in the PVE-TAVI's group was 75% regardless of the type of treatment. CONCLUSIONS The above findings show that IE following TAVI is a serious complication and various scenarios (also CDRiE and native valve IE) should be considered.
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Affiliation(s)
- Piotr Scisło
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kajetan Grodecki
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Rymuza
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Abstract
Infective endocarditis (IE) is an uncommon, life-threatening systemic disorder with significant morbidity and persistently high mortality. The age of the peak incidence of IE has shifted from 45 years in the 1950s to 70 years at the present time, and elderly people have a five-fold higher risk of IE than the general adult population. Elderly IE patients demonstrate a higher prevalence of coagulase-negative staphylococci, enterococci and Streptococcus bovis, and lower rates of infection by viridans group streptococci. Methicillin resistance is more prevalent in elderly patients as a consequence of increased nosocomial acquisition. The elderly are a vulnerable group in whom diagnosis is often difficult on account of non-specific presenting features and where higher prevalence of comorbidities contributes to adverse outcomes. Treatment of older patients with IE presents specific challenges associated with prolonged antibiotic therapy, and access to surgery may be denied on account of advanced age and attendant comorbidities. This practical review covers all aspects of elderly IE, including clinical and microbiological diagnosis and appropriate diagnostic procedures, initial antibiotic selection, antibiotic prophylaxis, considerations about antibiotic therapy and surgery.
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132
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Iung B, Bouleti C. A New Match Between Surgery and Transcatheter Aortic Valve Replacement: Fear the Endocarditis. J Am Coll Cardiol 2019; 73:1656-1658. [PMID: 30947918 DOI: 10.1016/j.jacc.2018.12.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/30/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Bernard Iung
- Cardiology Department, APHP, Bichat University Hospital, Paris, France; DHU Fire, Paris, France; Paris-Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Claire Bouleti
- Cardiology Department, APHP, Bichat University Hospital, Paris, France; DHU Fire, Paris, France
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133
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Butt JH, Ihlemann N, De Backer O, Søndergaard L, Havers-Borgersen E, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL. Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 73:1646-1655. [DOI: 10.1016/j.jacc.2018.12.078] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/12/2018] [Accepted: 12/30/2018] [Indexed: 12/21/2022]
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Salaun E, Aldebert P, Jaussaud N, Spychaj JC, Maysou LA, Collart F, Avierinos JF, Casalta JP, Cuisset T, Hubert S, Lambert M, Raoult D, Renard S, Habib G, Bonnet JL. Early Endocarditis and Delayed Left Ventricular Pseudoaneurysm Complicating a Transapical Transcatheter Mitral Valve-in-Valve Implantation: Percutaneous Closure Under Local Anesthesia and Echocardiographic Guidance. Circ Cardiovasc Interv 2019; 9:CIRCINTERVENTIONS.116.003886. [PMID: 27649718 DOI: 10.1161/circinterventions.116.003886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan Salaun
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Philippe Aldebert
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Nicolas Jaussaud
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Jean-Charles Spychaj
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Laurie Anne Maysou
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Frederic Collart
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Jean-François Avierinos
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Jean-Paul Casalta
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Thomas Cuisset
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Sandrine Hubert
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Marc Lambert
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Didier Raoult
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Sebastien Renard
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
| | - Gilbert Habib
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France.
| | - Jean-Louis Bonnet
- From the Department of Cardiology (E.S., P.A., J.-C.S., L.A.M., J.-F.A., T.C., S.H., M.L., S.R., G.H., J.-L.B.), Department of Cardiac Surgery (N.J., F.C.), and Department of Infectious Diseases (J.-P.C., D.R.), La Timone Hospital, Marseille, France
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Bando K. Surgeons should not willingly believe what they wish. J Thorac Cardiovasc Surg 2019; 157:e117-e118. [PMID: 33198017 DOI: 10.1016/j.jtcvs.2018.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
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136
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Methicillin-Resistant Staphylococcus aureus Prosthetic Valve Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2019; 32:32/2/e00041-18. [PMID: 30760474 DOI: 10.1128/cmr.00041-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Staphylococcus aureus prosthetic valve endocarditis (PVE) remains among the most morbid bacterial infections, with mortality estimates ranging from 40% to 80%. The proportion of PVE cases due to methicillin-resistant Staphylococcus aureus (MRSA) has grown in recent decades, to account for more than 15% of cases of S. aureus PVE and 6% of all cases of PVE. Because no large studies or clinical trials for PVE have been published, most guidelines on the diagnosis and management of MRSA PVE rely upon expert opinion and data from animal models or related conditions (e.g., coagulase-negative Staphylococcus infection). We performed a review of the literature on MRSA PVE to summarize data on pathogenic mechanisms and updates in epidemiology and therapeutic management and to inform diagnostic strategies and priority areas where additional clinical and laboratory data will be particularly useful to guide therapy. Major updates discussed in this review include novel diagnostics, indications for surgical management, the utility of aminoglycosides in medical therapy, and a review of newer antistaphylococcal agents used for the management of MRSA PVE.
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137
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McElhinney DB, Aboulhosn JA, Dvir D, Whisenant B, Zhang Y, Eicken A, Ribichini F, Tzifa A, Hainstock MR, Martin MH, Kornowski R, Schubert S, Latib A, Thomson JD, Torres AJ, Meadows J, Delaney JW, Guerrero ME, Salizzoni S, El-Said H, Finkelstein A, George I, Gewillig M, Alvarez-Fuente M, Lamers L, Cheema AN, Kreutzer JN, Rudolph T, Hildick-Smith D, Cabalka AK, Boudjemline Y, Milani G, Bocks ML, Asnes JD, Mahadevan V, Himbert D, Goldstein BH, Fagan TE, Cheatham JP, Momenah TS, Kim DW, Colombo A, Ancona M, Butera G, Forbes TJ, Horlick E, Pedra C, Alfonsi J, Jones TK, Foerster S, Shahanavaz S, Crittendon I, Schranz D, Qureshi A, Thomas M, Kenny DP, Hoyer M, Bleiziffer S, Kefer J, Testa L, Gillespie M, Khan D, Pass RH, Abdel-Wahab M, Wijeysundera H, Casselman F, Moe T, Hayes N, Alli O, Nayak KR, Patel P, Piazza N, Seaman C, Windecker S, Kuo J, Ing FF, Makkar RR, Greif M, Cerillio AG, Champagnac D, Nietlispach F, Maisano F, Treede H, Seiffert M, Teles RC, Feuchtner G, Bonaros N, Bruschi G, Pesarini G. Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. J Am Coll Cardiol 2019; 73:148-157. [DOI: 10.1016/j.jacc.2018.10.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/30/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
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138
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Kolte D, Goldsweig A, Kennedy KF, Abbott JD, Gordon PC, Sellke FW, Ehsan A, Sodha N, Sharaf BL, Aronow HD. Comparison of Incidence, Predictors, and Outcomes of Early Infective Endocarditis after Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in the United States. Am J Cardiol 2018; 122:2112-2119. [PMID: 30292332 DOI: 10.1016/j.amjcard.2018.08.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023]
Abstract
Infective endocarditis (IE) of prosthetic or bioprosthetic heart valves is a serious complication associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after transcatheter aortic valve implantation (TAVI) in the United States are limited. We used the 2013 to 2014 Nationwide Readmissions Databases to determine the incidence of early IE after TAVI and surgical aortic valve replacement (SAVR) in the US. Clinical characteristics, independent predictors, and outcomes of patients with IE post-TAVI were examined. In 29,306 TAVI and 66,077 SAVR patients, the incidence rates of early IE were 1.7% (95% confidence interval [CI] 1.5% to 1.9%) and 2.5% (95% CI 2.3% to 2.9%) per person-year, respectively. In a propensity-matched cohort of 15,138 TAVI and 15,030 SAVR patients (weighted), there were no significant differences in the incidence rates of IE (1.7% [95% CI 1.4% to 2.0%] vs 1.9% [95% CI 1.6% to 2.2%] per person-year, log-rank p = 0.29) or in the median (interquartile range) time to IE (91 [48 to 146] vs 92 [61 to 214] days, p = 0.13). Staphylococcus (30.4%), Streptococcus (29.9%), and Enterococcus (20.5%) were the most common causative organisms of IE post-TAVI. Younger age, history of heart failure, need for permanent pacemaker placement, cardiac arrest, major bleeding, and sepsis during the index TAVI hospitalization were independently associated with an increased risk of IE. In-hospital mortality rate during readmission for IE was 15.6%. In conclusion, in a nationally representative cohort of TAVI patients in the US, the incidence rate of early IE was 1.7% per person-year. Age, co-morbid conditions, invasive procedures, and complications during the index hospitalization were associated with incident IE post-TAVI.
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Affiliation(s)
- Dhaval Kolte
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | | | - Kevin F Kennedy
- Statistical Consultant, Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - J Dawn Abbott
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Paul C Gordon
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Frank W Sellke
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Afshin Ehsan
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Neel Sodha
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Barry L Sharaf
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island.
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139
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Abstract
Cardiac risk stratification before surgery informs consent, may advise optimization interventions, and guides intraoperative and postoperative management and monitoring. Published guidelines provide an outline for risk stratification but are only updated every 5 to 10 years; hence, cardiology expert opinion is often needed. Preoperative cardiovascular evaluation starts with an excellent history and physical examination. Accurate assessment of exercise tolerance is paramount in defining risk and determining the need for further testing. Risk/benefit ratio needs to be assessed and reviewed with all stakeholders, which pertains to deciding on cardiac intervention before surgery and bleeding versus thrombosis risk when managing medications.
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Affiliation(s)
- Vahé S Tateosian
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA.
| | - Deborah C Richman
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA
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140
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Gomes B, Geis NA, Leuschner F, Meder B, Konstandin M, Katus HA, Bekeredjian R. Periprocedural antibiotic treatment in transvascular aortic valve replacement. J Interv Cardiol 2018; 31:885-890. [DOI: 10.1111/joic.12567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/19/2018] [Accepted: 10/07/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bruna Gomes
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Nicolas A. Geis
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Florian Leuschner
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Benjamin Meder
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Mathias Konstandin
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Hugo A. Katus
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III; University of Heidelberg; Heidelberg Germany
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141
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New valves, old diagnostic problems. Int J Cardiol 2018; 271:398-399. [DOI: 10.1016/j.ijcard.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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142
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Shahanavaz S, McElhinney DB. Transcatheter pulmonary valve replacement: evolving indications and application. Future Cardiol 2018; 14:511-524. [DOI: 10.2217/fca-2018-0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The introduction of transcatheter therapy for valvular heart disease has changed the spectrum of care of patients with a variety of cardiovascular conditions. Transcatheter valve placement has become established as a method of treating pathologic regurgitation or stenosis of the pulmonary valve, right ventricular outflow tract or a right ventricle to pulmonary artery conduit. In this review, we examine the pathophysiology of and indications for transcatheter pulmonary valve replacement along with procedural complications. Advancements in clinical application and valve technology will also be covered.
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Affiliation(s)
- Shabana Shahanavaz
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, 63110, MO, USA
| | - Doff B McElhinney
- Departments of Pediatrics & Cardiothoracic Surgery, Lucile Packard Children’s Hospital Heart Center, Stanford University School of Medicine, Palo Alto, Stanford-94304-5731, CA, USA
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143
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Infective endocarditis after transcatheter aortic valve implantation: Contributions of a single-centre experience on incidence and associated factors. Enferm Infecc Microbiol Clin 2018; 37:428-434. [PMID: 30389267 DOI: 10.1016/j.eimc.2018.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.
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144
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Moufarrej R, Aljaberi N. Prosthetic valve endocarditis secondary to Corynebacterium following transcatheter aortic valve implantation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty109. [PMID: 31020185 PMCID: PMC6426036 DOI: 10.1093/ehjcr/yty109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 09/04/2018] [Indexed: 12/02/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for the treatment of severe symptomatic aortic stenosis for patients at high risk for open surgery. Although experience with TAVI is increasing, few cases of post-TAVI endocarditis are reported. Case summary We present a case of an 87-year-old female patient who presented with fever, unresponsive to empiric antibiotics 3 months after a TAVI procedure for severe aortic valve stenosis. After some delay due to three hospitalizations in primary care hospitals, she was transferred to our general intensive care unit where the diagnosis of endocarditis due to Corynebacterium was made. The patient was transferred abroad to a specialized surgical centre of excellence and underwent aortic root and valve replacement with a homograft. After several post-operative complications the patient’s condition improved and is presently satisfactory. Discussion Keeping a high index of suspicion when evaluating patients might lead to a favourable outcome if appropriate and early intervention was implemented. Adherence to policies which address infection control and aseptic techniques when performing TAVI might lead to fewer cases of post-TAVI endocarditis.
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Affiliation(s)
- Ramzi Moufarrej
- Intensive Care Unit, Department of Internal Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Nahla Aljaberi
- Intensive Care Unit, Department of Internal Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
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145
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Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. J Infect Chemother 2018; 25:215-217. [PMID: 30243901 DOI: 10.1016/j.jiac.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/15/2018] [Accepted: 08/25/2018] [Indexed: 01/05/2023]
Abstract
The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.
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146
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Affiliation(s)
- Gilbert Habib
- Cardiology DepartmentAPHMLa Timone HospitalMarseilleFrance
- Aix Marseille UniversitéIRD, APHM, MEPHIIHU‐Méditerranée InfectionMarseilleFrance
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147
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Mangner N, Leontyev S, Woitek FJ, Kiefer P, Haussig S, Binner C, Mende M, Schlotter F, Stachel G, Höllriegel R, Hommel J, Binner‐Oussenek K, Misfeld M, Thiele H, Borger MA, Holzhey D, Linke A. Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2018; 7:e010027. [PMID: 30371173 PMCID: PMC6201426 DOI: 10.1161/jaha.118.010027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/04/2018] [Indexed: 01/14/2023]
Abstract
Background Infective endocarditis ( IE ) after transcatheter aortic valve replacement is a devastating complication associated with a high mortality. Our objective was to determine the impact of cardiac surgery (CS) and antibiotics ( IE - CS ) compared with medical treatment with antibiotics only ( IE - AB x) on 1-year mortality in patients developing IE after transcatheter aortic valve replacement. Methods and Results Patients developing IE after transcatheter aortic valve replacement were included in this retrospective analysis. All-cause 1-year mortality was the primary end point. A total of 20 patients underwent IE - CS compared with 44 patients treated by IE - AB x. In this unmatched cohort, patients treated by IE - AB x were older ( P=0.006), had a higher Society of Thoracic Surgeons score ( P=0.029), and more often had severe chronic kidney disease ( P=0.037). One-year mortality was not different between groups ( IE -CS versus IE-ABx, 65% versus 68.2%; P=0.802). The rate of any complication during treatment was higher in the IE - CS group ( P=0.024). In a matched cohort, baseline characteristics were not significantly different. All-cause 1-year mortality was not different between groups ( IE -CS versus IE-ABx, 65% versus 75%; P=0.490). A Cox regression analysis revealed any indication for surgery (hazard ratio, 6.20; 95% confidence interval, 1.80-21.41; P=0.004), sepsis on admission (hazard ratio, 4.03; 95% confidence interval, 1.97-8.24; P<0.001), and mitral regurgitation ≥2 (hazard ratio, 2.91; 95% confidence interval, 1.33-6.37) as factors associated with 1-year mortality. Conclusions In patients developing IE after transcatheter aortic valve replacement, mortality was predicted by the severity of IE and concomitant mitral regurgitation. In this small, and therefore statistically limited, but high-risk patient cohort, CS provided no significant mortality benefit compared with medical therapy. Individual decision making by a "heart and endocarditis team" is necessary to offer those patients the most reasonable treatment option.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
| | - Sergey Leontyev
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Felix J. Woitek
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
| | - Philipp Kiefer
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Stephan Haussig
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
| | - Christian Binner
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Meinhard Mende
- Institute for Medical Informatic, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Florian Schlotter
- Department of CardiologyHeart Center LeipzigUniversity HospitalLeipzigGermany
| | - Georg Stachel
- Department of CardiologyHeart Center LeipzigUniversity HospitalLeipzigGermany
| | - Robert Höllriegel
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
| | - Jennifer Hommel
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
| | | | - Martin Misfeld
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center LeipzigUniversity HospitalLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Michael A. Borger
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - David Holzhey
- Department of Cardiac SurgeryHeart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Axel Linke
- Department of Internal Medicine and CardiologyHeart Center DresdenTechnical University DresdenDresdenGermany
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148
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Tanase D, Ewert P, Hager A, Georgiev S, Cleuziou J, Hess J, Eicken A. Infective endocarditis after percutaneous pulmonary valve implantation – A long-term single centre experience. Int J Cardiol 2018; 265:47-51. [DOI: 10.1016/j.ijcard.2018.04.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 12/25/2022]
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149
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Yeo I, Kim LK, Park SO, Wong SC. In-hospital infective endocarditis following transcatheter aortic valve replacement: a cross-sectional study of the National Inpatient Sample database in the USA. J Hosp Infect 2018; 100:444-450. [PMID: 29803809 DOI: 10.1016/j.jhin.2018.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/20/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND While the utilization of transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis has been increasing, in-hospital infective endocarditis (IE) following TAVR has not been well described. AIM To identify in-hospital IE following TAVR. METHODS All patients who underwent TAVR between 2012 and 2014 were identified using the National Inpatient Sample database. Multi-variate logistic regression was performed to identify the predictors of in-hospital IE after TAVR. FINDINGS Of the 41,025 patients who received TAVR, 120 patients (0.3%) developed in-hospital IE. Viridans group streptococci (20.8%) was the most frequent causative organism for in-hospital IE, followed by Staphylococcus aureus (16.7%) and enterococci (8.3%). Patients who developed in-hospital IE after TAVR had significantly higher rates of death (20.8% vs 4.1%, P<0.001), septic shock (16.7% vs 0.8%, P<0.001), cardiogenic shock (12.5% vs 3.4%, P=0.02), acute kidney injury requiring haemodialysis (16.7% vs 1.6%, P<0.001), bleeding requiring transfusion (29.2% vs 11.3%, P=0.01), myocardial infarction (12.5% vs 2.1%, P<0.001) and permanent pacemaker removal (4.2% vs 0.05%, P<0.001) compared with patients without IE. Independent predictors of in-hospital IE after TAVR include younger age [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.89-0.95], drug abuse (OR 48.9, 95% CI 6.9-347.3) and human immunodeficiency virus (HIV) infection (OR 7.8, 95% CI 1.4-44.4). CONCLUSION IE occurred in 0.3% of patients after TAVR during the same hospitalization, resulting in higher rates of adverse outcomes including mortality. Patients with younger age, a history of drug abuse or HIV infection are at greater risk of in-hospital IE following TAVR, and would benefit from vigilant preventive measures perioperatively.
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Affiliation(s)
- I Yeo
- Division of Hospital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai/The Mount Sinai Hospital, New York, USA.
| | - L K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - S O Park
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, USA
| | - S C Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
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150
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Ibrahim A, Ahmed A, Kiernan T, Arnous S. Early prosthetic valve endocarditis after transcatheter aortic valve implantation using St Jude Medical Portico valve. BMJ Case Rep 2018; 2018:bcr-2018-225037. [PMID: 29764833 DOI: 10.1136/bcr-2018-225037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 87-year-old woman presented to the emergency department with a 2-week history of progressively worsening shortness of breath, fever and generalised myalgia. She underwent a transcatheter Portico aortic valve implantation for severe symptomatic aortic stenosis 3 months prior to this presentation. Examination revealed a temperature of 40°C and a systolic murmur in the aortic area. Inflammatory markers were elevated, and blood cultures were positive for methicillin-sensitive Staphylococcus aureus A possible diagnosis of infective endocarditis was made as one major and one minor criterion in the modified Duke criteria were fulfilled. Subsequent transoesophageal echocardiography (TOE) demonstrated vegetation attached to the prosthetic valve stent frame at the level of the left ventricular outflow tract. She was started on a prolonged course of intravenous antibiotics, and follow-up TOE, 4 weeks later, confirmed resolution of the vegetation. She was discharged home after prolonged hospital stay.
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Affiliation(s)
- Abdalla Ibrahim
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
| | - Aneeq Ahmed
- Cardiology Department, University of Limerick Hospitals Group, Limerick, Ireland
| | - Thomas Kiernan
- Cardiology Department, University of Limerick Hospitals Group, Limerick, Ireland
| | - Samer Arnous
- Cardiology Department, University of Limerick Hospitals Group, Limerick, Ireland
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