Infective endocarditis after transcatheter aortic valve implantation: a nationwide study

Henrik Bjursten, Magnus Rasmussen, Shahab Nozohoor, Mattias Götberg, Lars Olaison, Andreas Rück, Sigurdur Ragnarsson, Henrik Bjursten, Magnus Rasmussen, Shahab Nozohoor, Mattias Götberg, Lars Olaison, Andreas Rück, Sigurdur Ragnarsson

Abstract

Aims: Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study.

Methods and results: Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0-1.8%) the first year and 0.8% (0.6-1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49-68%), and 5-year survival was 29% (17-41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality.

Conclusion: The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients.

Clinical trial registration: NCT03768180 (http://clinicaltrials.gov/).

Keywords: Prosthetic valve endocarditis; Transcatheter aortic valve implantation.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

Figures

Figure 1
Figure 1
Patient flow. A study flowchart. Nationwide inclusion of patients receiving a transcatheter aortic valve implantation in Sweden since 2008. Group with prosthetic valve endocarditis was defined using the National Patient Registry and the Infective Endocarditis Registry.
Figure 2
Figure 2
Annual incidence of prosthetic valve endocarditis after transcatheter aortic valve implantation with 95% confidence interval up to 8 years after procedure.
Take home figure
Take home figure
Accumulated risk for developing prosthetic valve endocarditis. A Kaplan–Meier failure function for the risk of being diagnosed with prosthetic valve endocarditis in the study population. Curve truncated at 8 years due to small numbers.
Figure 3
Figure 3
Survival curve after diagnosis of prosthetic valve endocarditis. Kaplan–Meier survival estimates for survival after being diagnosed with prosthetic valve endocarditis, median follow-up 12.8 (interquartile range 3.6–24.0) months.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6911164/bin/ehz588f4.jpg

References

    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–1620.
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695–1705.
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL, Forrest JK, Tchétché D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ; Evolut Low Risk Trial Investigators. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019;380:1706–1715.
    1. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017;376:1321–1331.
    1. Feldman TE, Reardon MJ, Rajagopal V, Makkar RR, Bajwa TK, Kleiman NS, Linke A, Kereiakes DJ, Waksman R, Thourani VH, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Gleason TG, Tchetche D, Rovin JD, Buchbinder M, Meredith IT, Gotberg M, Bjursten H, Meduri C, Salinger MH, Allocco DJ, Dawkins KD.. Effect of mechanically expanded vs self-expanding transcatheter aortic valve replacement on mortality and major adverse clinical events in high-risk patients with aortic stenosis: the REPRISE III randomized clinical trial. JAMA 2018;319:27–37.
    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet J-P, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GMC, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa-Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet J-P, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh T, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Zamorano JL, Kzhdryan HK, Mascherbauer J, Samadov F, Shumavets V, Camp GV, Lončar D, Lovric D, Georgiou GM, Linhartova K, Ihlemann N, Abdelhamid M, Pern T, Turpeinen A, Srbinovska-Kostovska E, Cohen A, Bakhutashvili Z, Ince H, Vavuranakis M, Temesvári A, Gudnason T, Mylotte D, Kuperstein R, Indolfi C, Pya Y, Bajraktari G, Kerimkulova A, Rudzitis A, Mizariene V, Lebrun F, Demarco DC, Oukerraj L, Bouma BJ, Steigen TK, Komar M, De Moura Branco LM, Popescu BA, Uspenskiy V, Foscoli M, Jovovic L, Simkova I, Bunc M, de Prada JAV, Stagmo M, Kaufmann BA, Mahdhaoui A, Bozkurt E, Nesukay E, Brecker SJD.. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739–2791.
    1. Thornhill MH, Jones S, Prendergast B, Baddour LM, Chambers JB, Lockhart PB, Dayer MJ.. Quantifying infective endocarditis risk in patients with predisposing cardiac conditions. Eur Heart J 2018;39:586–595.
    1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL; ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075–3128.
    1. Habib G, Thuny F, Avierinos JF.. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis 2008;50:274–281.
    1. Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U.. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation 2017;136:329–331.
    1. Ostergaard L, Valeur N, Ihlemann N, Bundgaard H, Gislason G, Torp-Pedersen C, Bruun NE, Sondergaard L, Kober L, Fosbol EL.. Incidence of infective endocarditis among patients considered at high risk. Eur Heart J 2018;39:623–629.
    1. Mahesh B, Angelini G, Caputo M, Jin XY, Bryan A.. Prosthetic valve endocarditis. Ann Thorac Surg 2005;80:1151–1158.
    1. Edlin P, Westling K, Sartipy U.. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg 2013;95:1551–1556.
    1. Amat-Santos IJ, Ribeiro HB, Urena M, Allende R, Houde C, Bédard E, Perron J, DeLarochellière R, Paradis J-M, Dumont E, Doyle D, Mohammadi S, Côté M, San Roman JA, Rodés-Cabau J.. Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review. JACC Cardiovasc Interv 2015;8:334–346.
    1. Olsen NT, De Backer O, Thyregod HG, Vejlstrup N, Bundgaard H, Sondergaard L, Ihlemann N.. Prosthetic valve endocarditis after transcatheter aortic valve implantation. Circ Cardiovasc Interv 2015;8: pii: e001939.
    1. Butt JH, Ihlemann N, De Backer O, Søndergaard L, Havers-Borgersen E, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL.. Long-term risk of infective endocarditis after transcatheter aortic valve replacement. J Am Coll Cardiol 2019;73:1646–1655.
    1. Regueiro A, Linke A, Latib A, Ihlemann N, Urena M, Walther T, Husser O, Herrmann HC, Nombela-Franco L, Cheema AN, Le Breton H, Stortecky S, Kapadia S, Bartorelli AL, Sinning JM, Amat-Santos I, Munoz-Garcia A, Lerakis S, Gutiérrez-Ibanes E, Abdel-Wahab M, Tchetche D, Testa L, Eltchaninoff H, Livi U, Castillo JC, Jilaihawi H, Webb JG, Barbanti M, Kodali S, de Brito FS, Ribeiro HB, Miceli A, Fiorina C, Dato GMA, Rosato F, Serra V, Masson J-B, Wijeysundera HC, Mangione JA, Ferreira M-C, Lima VC, Carvalho LA, Abizaid A, Marino MA, Esteves V, Andrea JCM, Giannini F, Messika-Zeitoun D, Himbert D, Kim W-K, Pellegrini C, Auffret V, Nietlispach F, Pilgrim T, Durand E, Lisko J, Makkar RR, Lemos PA, Leon MB, Puri R, San Roman A, Vahanian A, Søndergaard L, Mangner N, Rodés-Cabau J.. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA 2016;316:1083–1092.
    1. Kolte D, Goldsweig A, Kennedy KF, Abbott JD, Gordon PC, Sellke FW, Ehsan A, Sodha N, Sharaf BL, Aronow HD.. Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States. Am J Cardiol 2018;122:2112–2119.
    1. Antman EM. Improving care at the population and individual level: lessons from SWEDEHEART. Eur Heart J 2018;39:3777–3779.
    1. Lindell F, Soderquist B, Sundman K, Olaison L, Kallman J.. Prosthetic valve endocarditis caused by Propionibacterium species: a national registry-based study of 51 Swedish cases. Eur J Clin Microbiol Infect Dis 2018;37:765–771.
    1. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR.. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–638.
    1. Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodes-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB; Valve Academic Research Consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg 2012;42:S45–S60.
    1. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R.. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9–13.
    1. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–612.
    1. Du Bois D, Du Bois EF.. Clinical calorimetry: tenth paper a formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916;XVII:863–871.
    1. Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U.. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50-69 years. Eur Heart J 2016;37:2658–2667.
    1. Oxenham H, Bloomfield P, Wheatley DJ, Lee RJ, Cunningham J, Prescott RJ, Miller HC.. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart 2003;89:715–721.
    1. Brennan JM, Edwards FH, Zhao Y, O'Brien S, Booth ME, Dokholyan RS, Douglas PS, Peterson ED, Team D.. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Circulation 2013;127:1647–1655.
    1. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH.. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 2000;36:1152–1158.
    1. Hoen B, Alla F, Selton SC, Beguinot I, Bouvet A, Briancon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le MV, Leport C, Mainardi JL, Ruimy R, Vandenesch F.. Association pour l'Etude et la Prevention de l'Endocardite Infectieuse Study G. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 2002;288:75–81.
    1. Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Akin J, Davidson MJ, Svensson LG; PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015;385:2477–2484.
    1. Mangner N, Woitek F, Haussig S, Schlotter F, Stachel G, Hollriegel R, Wilde J, Lindner A, Holzhey D, Leontyev S, Mohr FW, Schuler G, Linke A.. Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement. J Am Coll Cardiol 2016;67:2907–2908.
    1. Fariñas MC, Pérez-Vázquez A, Fariñas-Alvarez C, García-Palomo JD, Bernal JM, Revuelta JM, González-Macías J.. Risk factors of prosthetic valve endocarditis: a case-control study. Ann Thorac Surg 2006;81:1284–1290.
    1. Befus M, Lowy FD, Miko BA, Mukherjee DV, Herzig CT, Larson EL.. Obesity as a determinant of Staphylococcus aureus colonization among inmates in maximum-security prisons in New York State. Am J Epidemiol 2015;182:494–502.
    1. Salaun E, Sportouch L, Barral PA, Hubert S, Lavoute C, Casalta AC, Pradier J, Ouk D, Casalta JP, Lambert M, Gouriet F, Gaubert JY, Dehaene A, Jacquier A, Tessonnier L, Haentjens J, Theron A, Riberi A, Cammilleri S, Grisoli D, Jaussaud N, Collart F, Bonnet JL, Camoin L, Renard S, Cuisset T, Avierinos JF, Lepidi H, Mundler O, Raoult D, Habib G.. Diagnosis of infective endocarditis after TAVR: value of a multimodality imaging approach. JACC Cardiovasc Imaging 2018;11:143–146.

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