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Mangner N, Panagides V, 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, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Côté M, Thiele H, Holzhey D, Linke A, Rodés-Cabau J. Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. Clin Infect Dis 2023; 76:1003-1012. [PMID: 36331961 DOI: 10.1093/cid/ciac872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Echocardiography is the primary imaging modality for diagnosis of infective endocarditis (IE) in prosthetic valve endocarditis (PVE) including IE after transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the characteristics and clinical outcomes of patients with absent compared with evident echocardiographic signs of TAVI-IE. METHODS Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudo-aneurysm, intracardiac fistula, or valvular perforation or aneurysm. RESULTS Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device and had higher rates of peri-interventional complications (eg, stroke, major vascular complications) during the TAVI procedure (P < .05 for all). IE-neg had higher rates of IE caused by Staphylococcus aureus (33.7% vs 23.2%; P = .038) and enterococci (37.2% vs 23.8%; P = .009) but lower rates of coagulase-negative staphylococci (4.7% vs 20.0%, P = .001). IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (odds ratio: 1.51; 95% confidence interval [CI]: .55-4.12) as well as a for 1-year mortality in Cox regression analysis (hazard ratio: 1.10; 95% CI: .67-1.80). CONCLUSIONS Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation.
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Affiliation(s)
- Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Lisa Crusius
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Department of Cardiology, Normandie University, UNIROUEN, INSERM U1096, 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, Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR1099, 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
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | | | | | - Hervé Le Breton
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR1099, Rennes, France
| | | | - 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, Dresden, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- Clínic Barcelona, Barcelona, Spain
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Panagides V, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, 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, Eltchaninoff H, Sondergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Val DD, Linke A, Crusius L, Thiele H, Holzhey D, Rodés-Cabau J. Sex Differences in Infective Endocarditis After Transcatheter Aortic Valve Replacement. Can J Cardiol 2022; 38:1418-1425. [PMID: 35842172 DOI: 10.1016/j.cjca.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outcomes after transcatheter aortic valve replacement (TAVR) and infectious diseases may vary according to sex. METHODS This multicenter study aimed to determine the sex differences in clinical characteristics, management, and outcomes of infective endocarditis (IE) after TAVR. A total of 579 patients (217 women, 37.5%) were included retrospectively from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS Women were older (80±8 vs. 78±8 years, p=0.001) and exhibited a lower comorbidity burden. Clinical characteristics and microbiological profile were similar between men and women, but culture-negative IE was more frequent in women (9.9% vs. 4.3%, p=0.009). A high proportion of patients had a clinical indication for surgery (54.4% in both groups, p=0.99), but a surgical intervention was performed in a minority of patients (women: 15.2%, men: 20.3%, p=0.13). The mortality rate at index IE hospitalization was similar in both groups (women: 35.4%, men: 31.7%, p=0.373), but women exhibited a higher mortality rate at 2-year follow-up (63% vs. 52.1%, p=0.021). Female sex remained an independent risk factor for cumulative mortality in the multivariable analysis (HRadj: 1.28, 95% CI: 1.02-1.62, p=0.035). After adjustment for in-hospital events, surgery was not associated with better outcomes in women. CONCLUSIONS There were no significant sex-related differences in the clinical characteristics and management of IE after TAVR. However, female sex was associated with increased two-years mortality risk.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy; Ospedale San Raffaele, Milan, Italy
| | - Piotr Scislo
- Department of Cardiology, Medical University of Warsaw, Poland
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Poland
| | - 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, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; Augustinum Klinik München, München, Germany
| | - Azeem Latib
- Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy; Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Panagides V, del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, 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, Brito FSD, Dato GMA, Rosato F, Ferreira MC, de Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Breton HL, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation. Am J Cardiol 2022; 172:90-97. [PMID: 35387738 DOI: 10.1016/j.amjcard.2022.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
Abstract
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.
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Panagides V, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, 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, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Gervais P, Del Val D, Linke A, Crusius L, Thiele H, Holzhey D, Rodés-Cabau J. Very early infective endocarditis after transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:1087-1097. [PMID: 35262756 DOI: 10.1007/s00392-022-01998-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). OBJECTIVE The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. METHODS This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. RESULTS Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. CONCLUSION A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France
| | | | | | | | - Francesco Giannini
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
- Ospedale San Raffaele, Milan, Italy
| | - Piotr Scislo
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada
- Southlake Hospital, Newmarket, ON, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany
- Augustinum Klinik München, München, Germany
| | - Azeem Latib
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
- Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France
| | | | - Philippe Gervais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
- Hospital Clínic Barcelona, Barcelona, Spain.
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Panagides V, Del Val D, Abdel-Wahab M, Mangner N, 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, Won-Keun K, 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, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 75:638-646. [PMID: 34894124 DOI: 10.1093/cid/ciab1004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. METHODS This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. RESULTS A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all). CONCLUSION PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany.,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, Canada.,Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- 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
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, 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, USA.,Mount Sinai Hospital, New York, NY, 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
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao 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, NY, 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
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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7
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Val DD, Abdel-Wahab M, Mangner N, 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, Won-Keun K, 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, Vendramin I, 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, Corriea 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, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:102-112. [PMID: 34688853 DOI: 10.1016/j.cjca.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S aureus) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on S aureus IE after transcatheter aortic valve replacement (TAVR). METHODS Data was obtained from the Infectious Endocarditis after TAVR International Registry including patients with definite IE following TAVR from 59 centers in 11 countries. Patients were divided into two groups according to microbiological etiology (non-S aureus-IE, non-SA-IE vs. S aureus-IE, SA-IE). RESULTS SA-IE was identified in 141 out of 573 (24.6%) patients, methicillin-sensitive S aureus in most cases (115/141, 81.6%). SEV were more common than BEV in patients with early SA-IE. Major bleeding and sepsis complicating TAVR, neurological symptoms or systemic embolism at admission and IE with cardiac device involvement other than the TAVR prosthesis were associated with SA-IE (p<0.05 for all). Among IE post-TAVR patients, the likelihood of SA-IE increased from 19% in the absence of those risk factors to 84.6% if ≥3 risk factors were present. In-hospital (47.8% vs. 26.9%, p<0.001) and 2-year mortality (71.5% vs. 49.6%, p<0.001) rates were higher among SA-IE (vs. non-SA-IE) patients. Surgery at the time of index SA-IE was associated with a lower mortality rate at follow-up (HRadj: 0.46, 95% CI: 0.22-0.96, p=0.038). CONCLUSIONS SA-IE represented ∼ 25% of IE cases after TAVR and was associated with a very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA-IE and could help to orientate early antibiotic regimen selection. Surgery at index SA-IE was associated with improved outcomes, and its role should be evaluated in future studies.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; 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, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- 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, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA; Mount Sinai Hospital, New York, NY, 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
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao 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, NY, 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
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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8
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Del Val D, Abdel-Wahab M, Mangner N, 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, Won-Keun K, 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, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2276-2287. [PMID: 33958124 DOI: 10.1016/j.jacc.2021.03.233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. METHODS Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). RESULTS A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). CONCLUSIONS Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, 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, 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
| | | | - Kim Won-Keun
- 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 Marañón, 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, 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, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao 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
| | - Axel Linke
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
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9
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Del Val D, Abdel-Wahab M, Linke A, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Landt M, Auffret V, Sinning JM, Cheema A, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia A, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli A, 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, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, de Brito FS, Actis Dato GM, Rosato F, Ferreira MC, Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, 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, Mangner N, Crusius L, Holzhey D, Rodés-Cabau J. Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 73:e3750-e3758. [PMID: 33733675 DOI: 10.1093/cid/ciaa1941] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.
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Affiliation(s)
- David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Axel Linke
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Hôpital Charles Nicolle, University of Rouen, Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | | | - Asim Cheema
- St Michaels Hospital, Toronto, Canada.,Southlake Regional Health Centre, Newmarket, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsilvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañón, Hospital Gregorio Marañón, 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
| | | | | | | | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Fondazione Toscana G. Monasterio, Massa, Italy.,Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Susheel Kodali
- Columbia University Medical Center, New York, New York, USA
| | - Henrique B Ribeiro
- Instituto do Coração (Incor), Heart Institute, University of São Paulo, Sao Paulo, Brazil
| | | | - Fabio Sandoli de Brito
- Instituto do Coração (Incor), Heart Institute, University of São Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - 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
| | | | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | - Norman Mangner
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Servoz C, Wintzer-Wehekind J, Monségu J. [Infection and TAVI]. Ann Cardiol Angeiol (Paris) 2020; 69:400-403. [PMID: 33059876 DOI: 10.1016/j.ancard.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
Since trans-catheter valve implantation (TAVI) has emerged for severe symptomatic aortic stenosis treatment, infective endocarditis (IE) appears as a rare but severe complication. Like surgical aortic valve remplacement infective endocarditis (SAVR-IE), TAVI-IE has a noxious impact on morbidity and mortality. Compared to SAVR-IE, TAVI-IE present some similarities as well as differences. Most TAVI-IE occurred during the first year and enterococcus is the more common pathogen. A multimodality imaging approach including echocardiography, multislice computed tomography (CT) and positron emission tomography-CT with blood culture is necessary for the diagnosis. In this high-risk population, the vast majority of TAVI-IE patients are treated with antibiotic therapy alone. Consequently to the expanded indication, the increasing number of TAVI-IE will appear more frequently. If initially only few clinical cases of IE were reported, sparse observational multicenter registries have now been published. Relevant differences were noted on these registries, but some recent publications have provided new informations on IE. The present review reports incidence, symptoms, microbiological profil, risk factors and clinicals outcomes of TAVI-IE. Eventually, we describe the management and the treatment of IE in the context of TAVI.
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Affiliation(s)
- C Servoz
- Institut cardiovasculaire, Groupe Hospitalier Mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - J Wintzer-Wehekind
- Institut cardiovasculaire, Groupe Hospitalier Mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France
| | - J Monségu
- Institut cardiovasculaire, Groupe Hospitalier Mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France
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Servoz C, Bouisset F, Marcheix B, Grunenwald E, Carrié D, Boudou N, Campelo-Parada F, Chollet T, Lhermusier T. Infective endocarditis after transcatheter aortic-valve implantation: Incidence, impact and treatment in a French university hospital. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Servoz C, Chollet T, Bouisset F, Carrié D, Boudou N, Campelo-Parada F, Marcheix B, Grunenwald E, Lhermusier T. Impact of lung diseases in patients undergoing on transaortic compared with transfemoral TAVI. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lattuca B, Barber-Chamoux N, Alos B, Sfaxi A, Mulliez A, Miton N, Levasseur T, Servoz C, Derimay F, Hachet O, Motreff P, Metz D, Lairez O, Mewton N, Belle L, Akodad M, Mathivet T, Ecarnot F, Pollet J, Danchin N, Steg PG, Juillière Y, Bouleti C. Impact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: A randomized trial. Am Heart J 2018; 200:67-74. [PMID: 29898851 DOI: 10.1016/j.ahj.2018.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 03/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Appropriate information about the benefits and risks of invasive procedures is crucial, but limited data is available in this field. The aim of this study was to evaluate the incremental value of a short video about coronary angiography compared with standard information, in terms of patient understanding, satisfaction and anxiety. METHODS This prospective multicenter study included patients admitted for scheduled coronary angiography, who were randomized to receive either standard information or video information by watching a three-dimensional educational video. After information was delivered, patients were asked to complete a dedicated 16-point information questionnaire, as well as satisfaction and anxiety scales. RESULTS From 21 September to 4 October 2015, 821 consecutive patients were randomized to receive either standard information (n=415) or standard information with an added educational video (n=406). The information score was higher in the video information group than in the standard group (11.8±2.8 vs 9.5±3.1; P<.001). This result was consistent across age and education level subgroups. Self-reported satisfaction was also higher in the video information group (8.4±1.9 vs. 7.7±2.3; P<.001), while anxiety level did not differ between groups. The variables associated with a higher information score were the use of the educational video, younger age, higher level of education, previous follow-up by a cardiologist, prior information about coronary angiography and previous coronary angiography. CONCLUSIONS In comparison with standard information, viewing a dedicated educational video improved patients' understanding and satisfaction before scheduled coronary angiography. These results are in favor of widespread use of this incremental information tool.
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