Pascal Meier, MD reviewing Regueiro A et al. JAMA 2016 Sep 13.

Infective endocarditis after transcatheter aortic-valve replacement is associated with high mortality in a large observational study.

Few studies have focused on factors associated with infective endocarditis after transcatheter aortic-valve replacement (TAVR) procedures. Now, researchers have analyzed registry data on 250 patients experiencing infective endocarditis out of approximately 20,000 TAVR patients from 47 centers.

Overall, endocarditis incidence was 1.1% per person-year. The median time from the procedure to onset of an endocarditis symptom was 5.3 months. Higher risks for developing infective endocarditis after TAVR were associated with male sex (hazard ratio, 1.69), diabetes mellitus (HR, 1.52), and moderate-to-severe aortic regurgitation (HR, 2.05); older age was associated with lower risk (HR, 0.97 per additional year). The most frequently observed microorganisms were Enterococcus species and Staphylococcus aureus (25% and 24%). The in-hospital mortality rate was 36%; surgery was necessary in 15% of cases during the disease episode. In-hospital mortality was associated with a higher logistic EuroSCORE (odds ratio, 1.03 per 1% increase), heart failure (OR, 3.36), and acute kidney injury (OR, 2.70). The 2-year mortality rate was 67%.

CITATION(S):

Regueiro A et al. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA 2016 Sep 13; 316:1083. 

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