Prosthetic valve endocarditis after transcatheter aortic valve implantation

TY - JOUR

T1 - Prosthetic valve endocarditis after transcatheter aortic valve implantation

AU - Olsen, Niels Thue

AU - De Backer, Ole

AU - Thyregod, Hans G H

AU - Vejlstrup, Niels Grove

AU - Bundgård, Henning

AU - Søndergaard, Lars

AU - Ihlemann, Nikolaj

N1 - © 2015 American Heart Association, Inc.

PY - 2015/4/21

Y1 - 2015/4/21

N2 - BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural risk factors.METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years (interquartile range, 0.5-2.5 years; longest follow-up was 6.3 years). TAVI-PVE was most frequent in the first year after implantation (first-year incidence, 3.1% [confidence interval, 1.4%-4.8%]); the overall annualized rate was 2.1% per patient-year (confidence interval, 1.2%-3.3%). Seventeen patients (94%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]).CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves. Conservative treatment was associated with an acceptable outcome. Suboptimal valve deployment and vascular complications were associated with an increased risk of TAVI-PVE.

AB - BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural risk factors.METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years (interquartile range, 0.5-2.5 years; longest follow-up was 6.3 years). TAVI-PVE was most frequent in the first year after implantation (first-year incidence, 3.1% [confidence interval, 1.4%-4.8%]); the overall annualized rate was 2.1% per patient-year (confidence interval, 1.2%-3.3%). Seventeen patients (94%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]).CONCLUSIONS: TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves. Conservative treatment was associated with an acceptable outcome. Suboptimal valve deployment and vascular complications were associated with an increased risk of TAVI-PVE.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve Stenosis

KW - Denmark

KW - Endocarditis, Non-Infective

KW - Female

KW - Follow-Up Studies

KW - Heart Valve Prosthesis

KW - Humans

KW - Incidence

KW - Male

KW - Postoperative Complications

KW - Risk Factors

KW - Survival Analysis

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

U2 - 10.1161/circinterventions.114.001939

DO - 10.1161/circinterventions.114.001939

M3 - Journal article

C2 - 25873728

SN - 1941-7640

VL - 8

SP - 1

EP - 10

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 4

M1 - e001939

ER -