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Cahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Hildick-Smith D, Redwood S, Prendergast BD. 3326Infective endocarditis after transcatheter aortic valve implantation: findings from a UK nationwide linkage study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Infective endocarditis (IE) is a potentially fatal complication of prosthetic valve replacement and increasing use of transcatheter aortic valve implantation (TAVI) has resulted in a new elderly and frail population at increased risk of IE. The incidence of IE after TAVI and factors that influence the risk and subsequent outcome are relatively unknown.
Purpose
To describe the incidence, predictors, echocardiographic findings, microbiology and clinical outcomes of IE following TAVI in the United Kingdom (UK).
Methods
Patients who underwent TAVI between Jan 1 2007 and Dec 31 2016 were identified from the UK TAVI database held by the National Institute for Cardiovascular Outcomes Research. For this cohort, all hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics Admitted Patient Care database, or by contact with regional TAVI centres. Additional information concerning clinical presentation, imaging findings, microbiology, management and patient outcome were obtained where possible from the treating physician.
Results
A total of 16,014 patients underwent TAVI, of whom 157 developed IE over a median follow-up of 23.8 (IQR 7.8–52.4) months - an overall incidence of 0.98% (0.53% at one year post-TAVI). The mean age of patients with IE was 79.2±7.8 years, and 69% were male. The median time to IE following TAVI was 10.0 (IQR 4.0–22.3) months.
On multivariate analysis, IE was significantly more common in men (HR 2.05, 95% CI 1.35–3.11, p=0.001) and in patients receiving mechanically-expandable (HR 2.15, 95% CI 1.16–4.01, p=0.015) or balloon-expandable valves (HR 1.60, 95% CI 1.01–2.52, p=0.045) compared to self-expanding valves. IE was also more common in those with an aortic valve peak gradient following TAVI deployment greater than median (HR 1.81, 95% CI 1.23–2.67, p=0.003).
The most common presenting symptom was fever (present in 67.1%). The most frequent causal organisms were enterococci (25.9%), followed by oral streptococci (16.4%) and Staphylococcus aureus (11.8%). Transoesophageal echocardiography demonstrated vegetations in 72.5% of patients, most commonly on the TAVI valve leaflets (58.8%). Only 8.24% of patients underwent surgical valve intervention.
Survival rates at hospital discharge and one year follow up were 61.4% and 54.4%, respectively. Specific factors associated with one-year mortality were cardiogenic shock (HR 4.6, 95% CI 2.1–10.3, p=0.0002), septic shock (HR 3.4, 95% CI 1.4–8.3, p=0.006) and stroke (HR 4.9, 95% CI 1.46–16.7, p=0.01).
Conclusions
The incidence of IE one year after TAVI was 0.53% and greater risk was associated with male sex, mechanically-expandable and balloon-expandable valves, and elevated post-deployment valve gradient. Enterococci were the most common causative organism. Overall survival at one year was 54.4%, with adverse outcome predicted by cardiogenic shock, septic shock or stroke.
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Affiliation(s)
- T J Cahill
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - J Raby
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - P D Jewell
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - P F Brennan
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | - A P Banning
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - J Byrne
- Kings College Hospital, Department of Cardiology, London, United Kingdom
| | - R K Kharbanda
- John Radcliffe Hospital, Department of Cardiology, Oxford, United Kingdom
| | - P A MacCarthy
- Kings College Hospital, Department of Cardiology, London, United Kingdom
| | - M H Thornhill
- University of Sheffield, Unit of Oral & Maxillofacial Medicine Surgery & Pathology, School of Clinical Dentistry,, Sheffield, United Kingdom
| | - J A T Sandoe
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Leeds, United Kingdom
| | - M S Spence
- Belfast Health and Social Care Trust, Department of Cardiology, Belfast, United Kingdom
| | | | - S Redwood
- St Thomas' Hospital, Department of Cardiology, London, United Kingdom
| | - B D Prendergast
- St Thomas' Hospital, Department of Cardiology, London, United Kingdom
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Affiliation(s)
- T J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, UK
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Cahill TJ, Jewell PD, Denne L, Franklin RC, Frigiola A, Orchard E, Prendergast BD. Contemporary epidemiology of infective endocarditis in patients with congenital heart disease: A UK prospective study. Am Heart J 2019; 215:70-77. [PMID: 31299559 DOI: 10.1016/j.ahj.2019.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Infective endocarditis is a life-threatening complication of congenital heart disease (CHD), but there are few studies concerning the contemporary risk profile, preceding invasive procedures and outcomes in this patient population. The aim of this study was to investigate the epidemiology of infective endocarditis (IE) in patients with CHD. METHODS Cases of IE in children and adults with CHD were prospectively recorded as part of the UK National Institute for Cardiovascular Outcomes Research (NICOR) National Congenital Heart Disease Audit. Patients were entered into the database between April 2008 and March 2016. RESULTS Eight hundred episodes of IE were recorded in 736 patients with CHD. Sixty-five patients (9%) were infants (aged <1 year), 235 (32%) were children (aged 1-15 years), and 436 (59%) were adults (aged >15 years). The most common diagnoses were Tetralogy of Fallot (n = 150, 22.8%), ventricular septal defect (n = 129, 19.6%) and bicuspid aortic valve (n = 70, 10.7%). Dental procedures preceded 67 of 635 episodes (11%) of IE, and non-dental invasive procedures preceded 177 of 644 episodes (27.4%). The most common causative organisms were streptococci, accounting for 40% of cases. Overall in-hospital mortality was 6.7%. On multivariable analysis, adverse factors associated with in-hospital mortality were staphylococcal infection and presence of an underlying atrioventricular septal defect. CONCLUSIONS Infective endocarditis in patients with CHD is an ongoing clinical challenge. In contemporary practice in tertiary congenital centers, 1 of 15 patients do not survive to hospital discharge. Streptococci remain the most common causative organism, and antecedent dental or medical procedures were undertaken in a significant minority in the 3 months before diagnosis. The presence of an atrioventricular septal defect or staphylococcal infection is associated with significantly increased risk of early mortality.
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Thornhill MH, Chambers JB, Prendergast BD, Dayer M, Cahill TJ, Lockhart PB, Baddour LM. Antibiotic prophylaxis: Back from the brink. Br Dent J 2018; 225:579-580. [DOI: 10.1038/sj.bdj.2018.875] [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: 11/09/2022]
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Jewell P, Cahill TJ, Denne L, Cunningham D, Franklin R, Frigiola A, Prendergast BD. P2470Contemporary epidemiology of infective endocarditis in patients with congenital heart disease: outcomes from a national prospective study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Jewell
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - T J Cahill
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - L Denne
- National Institute for Cardiovascular Outcomes Research, London, United Kingdom
| | - D Cunningham
- National Institute for Cardiovascular Outcomes Research, London, United Kingdom
| | - R Franklin
- Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - A Frigiola
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - B D Prendergast
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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Cahill TJ, Chen M, Hayashida K, Latib A, Modine T, Piazza N, Redwood S, Søndergaard L, Prendergast BD. Transcatheter aortic valve implantation: current status and future perspectives. Eur Heart J 2018; 39:2625-2634. [PMID: 29718148 DOI: 10.1093/eurheartj/ehy244] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- T J Cahill
- Oxford Heart Centre, Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue St, Chengdu, China
| | - K Hayashida
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - T Modine
- Service de Chirurgie Cardio-Vasculaire, Hôpital Cardiologique, CHRU de Lille, 2 Avenue Oscar Lambret, Lille, France
| | - N Piazza
- Department of Interventional Cardiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, Quebec, Canada
| | - S Redwood
- Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
| | - L Søndergaard
- Heart Center, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - B D Prendergast
- Department of Cardiology, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
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Ali MA, Penfold RS, Patel I, MacGregor T, Cahill TJ, Alie AM, Shankar S, Nguyen M, Finlayson AET, Mahmud I. The Palestinian territories: barriers to healthcare and medical education and the strategic role of distance-learning partnerships in education systems strengthening. Med Confl Surviv 2014; 30:11-8. [PMID: 24684019 DOI: 10.1080/13623699.2014.873644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Cahill TJ, Nagaratnam K, Browning R, Anthony S, Dwight J. A case of loin pain: a cause close to the heart. BMJ 2012; 345:e6644. [PMID: 23077323 DOI: 10.1136/bmj.e6644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- T J Cahill
- Acute General Medicine, John Radcliffe Hospital, Oxford, UK.
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Cahill TJ, Bowes P, Duncan E, Drye E, Sen S, Miller C, Reshamwalla S, Andrew C, Ward M, Bakhai A. Risk Stratification by Cardiac Biomarkers following Emergency Gastrointestinal Surgery. ACTA ACUST UNITED AC 2011. [DOI: 10.5402/2011/403130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perioperative cardiac complications are a major cause of death following emergency gastrointestinal surgery. Early diagnosis of subclinical myocardial injury and infarction may be improved by screening with cardiac biomarkers. The aim of this study was to assess the predictive value of troponin I (TnI) and B-type natriuretic peptide (BNP) in the early postoperative period after emergency gastrointestinal surgery. We prospectively recruited 48 patients undergoing major emergency surgery for gastrointestinal or colorectal pathology in a single district general hospital. The primary endpoint was mortality at 90 days following surgery. Overall survival was 81.3% (39/48), with 9 postoperative deaths. Elevated TnI (≥0.03 ng ) was the best predictor of mortality, associated with an odds ratio of death by 90 days of 14.3 (95% CI 1.50–337, ). A postoperative BNP concentration >408.5 pg was associated with an odds ratio of death by 90 days of 13.6 (95% CI 2.03–106, ). A single measurement of postoperative BNP and TnI is a powerful predictor of short- to medium-term mortality in patients after emergency gastrointestinal surgery. Further work is required to demonstrate that cardiac biomarkers have independent predictive power and that patient outcomes can be improved.
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Affiliation(s)
- T. J. Cahill
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - P. Bowes
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - E. Duncan
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - E. Drye
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - S. Sen
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - C. Miller
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - S. Reshamwalla
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - C. Andrew
- Department of Biochemistry, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - M. Ward
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - A. Bakhai
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
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Cahill TJ, Slater A, Travis SPL. Keeping abdominal pain in the family. Gut 2011; 60:1711, 1738. [PMID: 21159600 DOI: 10.1136/gut.2010.223701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- T J Cahill
- Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, John Radcliffe Hospital, Oxford, UK
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Curran PJ, Cahill TJ. Letter: False claims under Medicare. Ann Intern Med 1975; 82:287. [PMID: 1090227 DOI: 10.7326/0003-4819-82-2-287_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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