1. Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death
- Author
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Marina Urena, Hervé Le Breton, Ugolino Livi, Susheel Kodali, Alec Vahanian, Maria Cristina Ferreira, Francesco Giannini, Luca Testa, Dominique Himbert, Alexandre Abizaid, Asim N. Cheema, Josep Rodés-Cabau, Juan C. Castillo, Francesco Rosato, Vicenç Serra, Vinicius Esteves, Won-Keun Kim, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Henrique Barbosa Ribeiro, Vincent Auffret, Azeem Latib, Thomas Pilgrim, Julio Andrea, José Armando Mangione, Marco Barbanti, Marcos Antonio Marino, Alberto San Roman, Oliver Husser, Luis Nombela-Franco, Rishi Puri, Harindra C. Wijeysundera, Didier Tchetche, John G. Webb, Claudia Fiorina, Luiz A. Carvalho, Hélène Eltchaninoff, Nikolaj Ihlemann, Valter Correa Lima, Howard C. Herrmann, John Lisko, Axel Linke, Ander Regueiro, Pedro A. Lemos, Jean Bernard Masson, Mohamed Abdel-Wahab, Lars Søndergaard, David Messika-Zeitoun, Enrique Gutiérrez-Ibañes, Stamatios Lerakis, Costanza Pellegrini, Raj Makkar, Jan Malte Sinning, Antonio J. Muñoz-García, Norman Mangner, Eric Durand, Antonio L. Bartorelli, Antonio Miceli, Stefan Stortecky, Ignacio J. Amat-Santos, Martin B. Leon, Samir R. Kapadia, Thomas Walther, Hasan Jilaihawi, Fabian Nietlispach, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval, Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de cardiologie [CHU Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Nouvelles Cibles Pharmacologiques de la Protection Endothéliale et de l'Insuffisance Cardiaque (EnVI), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie, Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Fundacion Alfonso Martin Escudero, Madrid, Spain, Université Laval [Québec] (ULaval), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Male ,medicine.medical_treatment ,2-year outcomes ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Interquartile range ,Odds Ratio ,implantation ,Hospital Mortality ,Registries ,030212 general & internal medicine ,multicenter registry ,Endocarditis ,Medicine (all) ,Incidence (epidemiology) ,Mortality rate ,Hazard ratio ,Age Factors ,Bacterial ,regurgitation ,Aged ,Endocarditis, Bacterial ,Female ,Follow-Up Studies ,Heart Failure ,Humans ,Sex Factors ,Staphylococcal Infections ,Staphylococcus aureus ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,General Medicine ,3. Good health ,Infective endocarditis ,impact ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,metaanalysis ,medicine.medical_specialty ,prevalence ,03 medical and health sciences ,early surgery ,medicine ,business.industry ,Odds ratio ,medicine.disease ,Surgery ,predictors ,business - Abstract
International audience; IMPORTANCE Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% Cl, 1.1%44%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% C1,1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% Cl, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% Cl, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% Cl, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% Cl, 19.1%-30.1% and 23.3%; 95% Cl, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% Cl, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% Cl, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% C1,1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% Cl, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% C1,1.42-5.11). The 2-year mortality rate was 66.7% (95% Cl, 59.0%-74.2%; 132 deaths; 115 survivors). CONCLUSIONS AND RELEVANCE Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.
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- 2016