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Martínez-Sellés M, Muñoz P. Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditis. J Clin Med 2023; 12:5705. [PMID: 37685770 PMCID: PMC10488693 DOI: 10.3390/jcm12175705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Infective endocarditis (IE) has experienced enormous changes in recent decades [...].
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Affiliation(s)
- Manuel Martínez-Sellés
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, 28001 Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, 28009 Madrid, Spain;
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
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2
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Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
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Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
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Mangner N, del Val D, Abdel-Wahab M, Crusius L, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Côté M, Holzhey D, Linke A, Rodés-Cabau J. Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2022; 79:772-785. [PMID: 35210032 DOI: 10.1016/j.jacc.2021.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. OBJECTIVES The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). METHODS Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. RESULTS Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. CONCLUSIONS In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications.
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Affiliation(s)
- Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Germany. https://twitter.com/NormanMangner
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/David_delVal_
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Lisa Crusius
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St. Michaels Hospital, Toronto, Ontario, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, Georgia, USA; Mount Sinai Hospital, New York, New York, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | - Susheel Kodali
- Columbia University Medical Center, New York, New York, USA
| | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, New York, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Marouane Boukhris
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic Barcelona, Barcelona, Spain.
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Transcatheter aortic valve replacement associated infective endocarditis case series: broadening the criteria for diagnosis is the need of the hour. BMC Cardiovasc Disord 2021; 21:559. [PMID: 34800994 PMCID: PMC8606088 DOI: 10.1186/s12872-021-02364-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Transcatheter valve replacement (TAVR) is an important therapeutic intervention for patients with aortic valve stenosis. As TAVR has become available to a broader population, there has been an increase in the number of less common, yet potentially catastrophic, complications. TAVR related infective endocarditis (TAVR-IE) is a rare, but potentially fatal, complication. Case series We present here two patients that we encountered for TAVR associated infective endocarditis. Our first patient presented 5 weeks after his TAVR. His initial presentation was consistent with signs of sepsis. The patient then developed Mobitz type I block during hospital course. His TEE was negative for features of infective endocarditis. Due to high suspicion, patient was taken for surgical exploration and was found to have multiple foci of vegetation adhered to the stent frame. Our second patient presented with new onset pulmonary edema, worsening heart failure and systemic inflammatory response. A TEE was done for persistent MSSA bacteremia which showed stable prosthetic valve function with no signs of infective endocarditis. Patient was discharged with a prolonged course of intravenous antibiotics. Patient was re-admitted for worsening sepsis and blood cultures were positive for MSSA. Patient was taken for surgical exploration of his prosthetic aortic valve which showed purulent aortic root abscess. Conclusion Through these cases, we aim to raise awareness on TAVR-IE. Due to the atypical clinical presentation, the modified Duke criteria may not be sufficient to diagnose TAVR-IE. Transesophageal echocardiogram in TAVR-IE may be negative or indeterminate. Prosthetic valve shadow may obscure smaller vegetations and/or smaller abscesses. A negative transesophageal echocardiogram should not rule out TAVR-IE and further diagnostic imaging modalities should be considered. PET/CT after administration of 18F-FDG (fluorodeoxyglucose) is a useful diagnostic tool in the diagnosis of infective endocarditis where TEE has been negative or inconclusive. Multi-modal imaging, in addition to the modified Duke criteria, can facilitate early diagnosis and improved mortality outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02364-0.
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Malvindi PG, Luthra S, Sarvananthan S, Zingale A, Olevano C, Ohri S. Surgical treatment of transcatheter aortic valve infective endocarditis. Neth Heart J 2020; 29:71-77. [PMID: 33021696 PMCID: PMC7843714 DOI: 10.1007/s12471-020-01494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
There is growing interest in infections occurring after transcatheter aortic valve implantation (TAVI). The incidence, and clinical and anatomical features suggest many similarities with prosthetic valve endocarditis. The survival of patients with an infected TAVI prosthesis is generally poor; however, only a minority of them (10%) have undergone treatment with surgical explantation of the infected prosthesis. A literature search was performed using online databases. Papers reporting surgical treatment of TAVI prosthesis infections were retrieved, focusing on pre- and intraoperative characteristics and early outcome. Thirty-seven papers ultimately provided information on 107 patients. Their mean ± standard deviation (SD) age was 76 ± 8 years and 72% were male. The mean ± SD time interval between the TAVI procedure and reoperation was 10 ± 10 months. Annular abscess formation was described in 34% of cases and mitral valve involvement in 31%. All patients underwent TAVI prosthesis explantation and surgical aortic valve replacement; concomitant mitral valve replacement was necessary in 22% of cases. Postoperative in-hospital mortality was 28%. Surgical explantation of infected TAVI prostheses was associated with a high postoperative mortality, although these initial experiences included elderly and high-risk patients. Considering the expansion of TAVI procedures towards younger and lower-risk patients, surgical treatment of TAVI endocarditis may represent the best option for a life-saving procedure.
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Affiliation(s)
- P G Malvindi
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK.
| | - S Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - S Sarvananthan
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - A Zingale
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - C Olevano
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - S Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
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Alexis SL, Malik AH, George I, Hahn RT, Khalique OK, Seetharam K, Bhatt DL, Tang GHL. Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review. J Am Heart Assoc 2020; 9:e017347. [PMID: 32772772 PMCID: PMC7660802 DOI: 10.1161/jaha.120.017347] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre-2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle-Ottawa Scale. Thirty-three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%-1.2% per patient-year versus 0.6%-3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo-leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline-directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.
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Affiliation(s)
- Sophia L. Alexis
- Department of Cardiovascular SurgeryMount Sinai Medical CenterNew YorkNY
| | - Aaqib H. Malik
- Department of MedicineWestchester Medical CenterValhallaNY
| | - Isaac George
- Division of Cardiac SurgeryColumbia University Medical CenterNew YorkNY
| | - Rebecca T. Hahn
- Division of CardiologyColumbia University Medical CenterNew YorkNY
| | - Omar K. Khalique
- Division of CardiologyColumbia University Medical CenterNew YorkNY
| | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular CenterHarvard Medical SchoolBostonMA
| | - Gilbert H. L. Tang
- Department of Cardiovascular SurgeryMount Sinai Medical CenterNew YorkNY
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Østergaard L, Lauridsen TK, Iversen K, Bundgaard H, Søndergaard L, Ihlemann N, Moser C, Fosbøl E. Infective endocarditis in patients who have undergone transcatheter aortic valve implantation: a review. Clin Microbiol Infect 2020; 26:999-1007. [DOI: 10.1016/j.cmi.2020.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
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Ali N, Baig W, Wu J, Blackman D, Gillott R, Sandoe JA. Prosthetic valve endocarditis following transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2020; 21:510-516. [DOI: 10.2459/jcm.0000000000000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaur S, Misbah Rameez R, Jaber W, Griffin BP, Xu B. Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: A Clinical Update. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1733718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rabel Misbah Rameez
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Brian P. Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
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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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Sánchez Ledesma M, Elvira Laffond A, Arias Del Peso B, González Calle D. Infective Endocarditis after Transvalvular Aortic Replacement: A call for a joined effort to improve its results. Enferm Infecc Microbiol Clin 2020; 38:249. [PMID: 31924379 DOI: 10.1016/j.eimc.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- María Sánchez Ledesma
- Servicio de Medicina Interna (Enfermedades Infecciosas), Hospital Clínico de Salamanca, Salamanca, España; Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, España
| | - Ana Elvira Laffond
- Servicio de Medicina Interna (Enfermedades Infecciosas), Hospital Clínico de Salamanca, Salamanca, España; Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, España
| | - Borja Arias Del Peso
- Servicio de Medicina Interna (Enfermedades Infecciosas), Hospital Clínico de Salamanca, Salamanca, España; Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, España
| | - David González Calle
- Servicio de Medicina Interna (Enfermedades Infecciosas), Hospital Clínico de Salamanca, Salamanca, España; Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, España.
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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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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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Searching for the best agent for antibiotic prophylaxis in patients undergoing transcatheter aortic valve implantation. J Hosp Infect 2018; 100:458-459. [DOI: 10.1016/j.jhin.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022]
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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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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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Affiliation(s)
- Gilbert Habib
- Cardiology DepartmentAPHMLa Timone HospitalMarseilleFrance
- Aix Marseille UniversitéIRD, APHM, MEPHIIHU‐Méditerranée InfectionMarseilleFrance
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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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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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Zegri-Reiriz I, de Alarcón A, Muñoz P, Martínez Sellés M, González-Ramallo V, Miro JM, Falces C, Gonzalez Rico C, Kortajarena Urkola X, Lepe JA, Rodriguez Alvarez R, Reguera Iglesias JM, Navas E, Dominguez F, Garcia-Pavia P. Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse. J Am Coll Cardiol 2018; 71:2731-2740. [PMID: 29903346 DOI: 10.1016/j.jacc.2018.03.534] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. OBJECTIVES This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. METHODS This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). RESULTS BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. CONCLUSIONS IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
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Affiliation(s)
- Isabel Zegri-Reiriz
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | - Patricia Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Victor González-Ramallo
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clínic- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Carles Falces
- Department of Cardiology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Claudia Gonzalez Rico
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | | | | | - Enrique Navas
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain.
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How TAVI registries report clinical outcomes-A systematic review of endpoints based on VARC-2 definitions. PLoS One 2017; 12:e0180815. [PMID: 28910289 PMCID: PMC5598923 DOI: 10.1371/journal.pone.0180815] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/21/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an alternative treatment for severe aortic stenosis in patients considered as high surgical risk. Since its first human implantation by Cribier et al., TAVI has been shown to increase survival rate and quality of life for high surgical risks patients. The objective of this study is to provide an overview of TAVI registries and the reporting clinical outcomes based on the VARC-2 definitions. In addition, the comparability and adherence of VARC-2 reporting within the identified TAVI registries was reviewed. Materials and methods A systematic review of TAVI registries reporting VARC-2 definitions has been performed in line with PRISMA guidelines in PubMed, ScienceDirect, Scopus databases and EMBASE. Based on VARC-2, patients’ characteristics and procedure characteristics, 30-day clinical outcomes, 1-year mortality and composited endpoints were extracted from each registry’s publications. Results This review identified 466 studies that were potentially relevant, and 20 TAVI registries reported VARC-2 definitions involved in our present review. Of all 20 registries, an overall sample size of 12,583 patients was involved. The 30-day all-cause mortality ranged from 0 to 12.7%. From 20 registries, 14 registries reported the cardiovascular mortality at 30 days. 9 registries reported myocardial infarction (MI) rate based on VARC-2 definitions, and 7 registries reported peri-procedural MI rate (<72h). In our review, most of registries presented MI rates ranging from 0.5% to 2%. The majority of registries have reported complications such as bleeding, vascular complications and new pacemaker implantation. Conclusion Since the introduction of VARC definitions from 2011, VARC and VARC-2 definitions are still not systematically used by all TAVI studies. These endpoint definitions warrant a concise and systemic analysis of outcome measures. Reporting TAVI-outcome uniformly makes study result comparison feasible. This definitely will increase patient safety, additionally to provide sufficient evidence to support decision makers like regulatory bodies, HTA agencies, payers.
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Martínez-Sellés M, Ariza-Solé A, Vidán MT, Formiga F. [Cardiogeriatrics: What do the current guidelines say about the elderly patient?]. Rev Esp Geriatr Gerontol 2017; 52:115-118. [PMID: 28222942 DOI: 10.1016/j.regg.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Universidad Europea, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat (Barcelona), España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España. CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES)
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
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Abstract
PURPOSE OF THE REVIEW Infective endocarditis (IE) is a relatively infrequent infectious disease. It does, however, causes serious morbidity, and its mortality rate has remained unchanged at approximately 25%. Changes in IE risk factors have deeply impacted its epidemiology during recent decades but literature from low-income countries is very scarce. Moreover, prophylaxis guidelines have recently changed and the impact on IE incidence is still unknown. RECENT FINDINGS In high-income countries, the proportion of IE related to prior rheumatic disease has decreased significantly and has been replaced proportionally by cases related to degenerative valvulopathies, prosthetic valves, and cardiovascular implantable electronic devices. Nosocomial and non-nosocomial-acquired cases have risen, as has the proportion caused by staphylococci, and the median age of patients. In low-income countries, in contrast, rheumatic disease remains the main risk factor, and streptococci the most frequent causative agents. Studies performed to evaluate impact of guidelines changes' have shown contradictory results. The increased complexity of cases in high-income countries has led to the creation of IE teams, involving several specialties. New imaging and microbiological techniques may increase sensitivity for diagnosis and detection of IE cases. In low-income countries, IE remained related to classic risk factors. The consequences of prophylaxis guidelines changes are still undetermined.
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Nitsan Z, Gelfand A, Appel S, Tikhmanovich N, Dorodnicov E, Shenker A, Reznik-Tzoref J, Kahana E, Milo R. Infective endocarditis mimicking parkinsonism and rapidly progressive dementia. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jalal Z, Galmiche L, Beloin C, Boudjemline Y. Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study. Arch Cardiovasc Dis 2016; 109:465-75. [PMID: 27346323 DOI: 10.1016/j.acvd.2016.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) using the bovine jugular vein Melody(®) valve (Medtronic Inc., Minneapolis, MN, USA) is safe and effective. However, post-procedural complications have been reported, the reasons for which are unclear. OBJECTIVE To assess the impact of PPVI procedural steps on valvular histology and leaflet mechanical behaviour. METHODS Three different valved stents (the Melody(®) valve and two homemade stents with bovine and porcine pericardium) were tested in vitro under four conditions: (1) control group; (2) crimping; (3) crimping plus inflation of low-pressure balloon; (4) condition III plus post-dilatation (high-pressure balloon). For each condition, valvular leaflets (and a venous wall sample for Melody(®) stents) were taken for histological analysis and mechanical uniaxial testing of the valve leaflets. RESULTS Among the Melody(®) valves, the incidence of transverse fractures was significantly higher in traumatized samples compared with the control group (P<0.05), whereas the incidence and depth of transverse fractures were not statistically different between the four conditions for bovine and porcine pericardial leaflets. No significant modification of the mechanical behaviour of in vitro traumatized Melody(®) valvular leaflets was observed. Bovine and porcine pericardia became more elastic and less resilient after balloon expansion and post-dilatation (conditions III and IV), with a significant decrease in elastic modulus and stress at rupture. CONCLUSION Valved stent implantation procedural steps induced histological lesions on Melody(®) valve leaflets. Conversely, bovine and porcine pericardial valved stents were not histologically altered by in vitro manipulations, although their mechanical properties were significantly modified. These data could explain some of the long-term complications observed with these substitutes.
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Affiliation(s)
- Zakaria Jalal
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France
| | - Louise Galmiche
- Hôpital Necker-Enfants-Malades, laboratoire d'anatomopathologie, 75015 Paris, France
| | - Christophe Beloin
- Unité de génétique des biofilms, département de microbiologie, institut Pasteur, 75015 Paris, France
| | - Younes Boudjemline
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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Dapás JI, Rivero C, Burgos P, Vila A. Pseudomonas aeruginosa Infective Endocarditis Following Aortic Valve Implantation: A Note of Caution. Open Cardiovasc Med J 2016; 10:28-34. [PMID: 27014375 PMCID: PMC4780508 DOI: 10.2174/1874192401610010028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/20/2015] [Accepted: 10/22/2015] [Indexed: 01/22/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe aortic valve stenosis (AS) in patients with prohibitive risk for surgical aortic valve replacement (SAVR). Prosthetic valve endocarditis (PVE) is a rare complication of this relatively novel procedure and current guidelines do not include specific recommendations for its treatment.
We report a case of PVE due to Pseudomonas aeruginosa after TAVI that required SAVR, with successful outcome. PVE usually occurs during the first year after TAVI and entails a high mortality risk because patients eligible for this min-imally invasive procedure are fragile (i.e. advanced age and/or severe comorbidities). Additionally, clinical presentation may be atypical or subtle and transesophageal echocardiogram (TEE) may not be conclusive, which delays diagnosis and treatment worsening the prognosis. This case highlights that open SAVR might be ultimately indicated as part of treatment for TAVI-PVE despite a high-risk surgery score.
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Affiliation(s)
- Juan Ignacio Dapás
- Department of Infectious Diseases, Hospital Italiano de Mendoza, Argentina
| | - Cynthia Rivero
- Department of Infectious Diseases, Hospital Italiano de Mendoza, Argentina
| | - Pablo Burgos
- Department of Cardiovascular Surgery, Hospital Italiano de Mendoza, Argentina
| | - Andrea Vila
- Department of Infectious Diseases, Hospital Italiano de Mendoza, Argentina
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