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Long-Term Outcomes After Infective Endocarditis After Transcatheter Aortic Valve Replacement

2020; Lippincott Williams & Wilkins; Volume: 142; Issue: 15 Linguagem: Inglês

10.1161/circulationaha.120.047469

1524-4539

David del Val, Axel Linke, Mohamed Abdel‐Wahab, Azeem Latib, Nikolaj Ihlemann, Marina Ureña, Won‐Keun Kim, Oliver Hüsser, Howard C. Herrmann, Luis Nombela‐Franco, Asim N. Cheema, Hervé Breton, Stefan Stortecky, Antonio L. Bartorelli, Jan Malte Sinning, Ignacio J. Amat‐Santos, Antonio J. Muñoz-García, Stamatios Lerakis, Enrique Gutiérrez, Martin Landt, Didier Tchétché, Luca Testa, Hélène Eltchaninoff, Ugolino Livi, Juan C. Castillo, Tarun Chakravarty, John G. Webb, Marco Barbanti, Susheel Kodali, Fábio Sândoli de Brito, Henrique Barbosa Ribeiro, Antonio Miceli, Claudia Fiorina, Guglielmo Mario Actis Dato, Francesco Rosato, Violeta Serra, Jean-Bernard Masson, Harindra C. Wijeysundera, José Armando Mangione, Maria Cristina Meira Ferreira, Valter C. Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Maynar-Mariño, Vinícius Esteves, Júlio Andrea, Dominique Himbert, Costanza Pellegrini, Vincent Auffret, Paolo Olivares, Fabian Nietlispach, Thomas Pilgrim, Éric Durand, John Lisko, Raj Makkar, Abdullah Alkhodair, Lars Søndergaard, Norman Mangner, Lisa Crusius, David Holzhey, Ander Regueiro, Josep Rodés‐Cabau,

Infectious Aortic and Vascular Conditions

HomeCirculationVol. 142, No. 15Long-Term Outcomes After Infective Endocarditis After Transcatheter Aortic Valve Replacement Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBLong-Term Outcomes After Infective Endocarditis After Transcatheter Aortic Valve Replacement David del Val, MD, Axel Linke, MD, Mohamed Abdel-Wahab, MD, Azeem Latib, MD, Nikolaj Ihlemann, MD, Marina Urena, MD, Kim Won-Keun, MD, Oliver Husser, MD, Howard C. Herrmann, MD, Luis Nombela-Franco, MD, Asim N. Cheema, MD, Hervé Le Breton, MD, Stefan Stortecky, MD, Antonio L. Bartorelli, MD, Jan Malte Sinning, MD, Ignacio Amat-Santos, MD, PhD, Antonio Munoz-Garcia, MD, Stamatios Lerakis, MD, Enrique Gutiérrez-Ibanez, MD, Martin Landt, MD, Didier Tchetche, MD, Luca Testa, MD, Helene Eltchaninoff, MD, Ugolino Livi, MD, Juan Carlos Castillo, MD, Tarun Chakravarty, MD, John G. Webb, MD, Marco Barbanti, MD, Susheel Kodali, MD, Fabio S. de Brito Jr, MD, Henrique Barbosa Ribeiro, MD, Antonio Miceli, MD, Claudia Fiorina, MD, Guglielmo Mario Actis Dato, MD, Francesco Rosato, MD, Vicenç Serra, MD, Jean-Bernard Masson, MD, Harindra C. Wijeysundera, MD, Jose A. Mangione, MD, Maria-Cristina Ferreira, MD, Valter Correa Lima, MD, Alexandre Siciliano Colafranceschi, MD, Alexandre Abizaid, MD, Marcos Antonio Marino, MD, Vinicius Esteves, MD, Julio C.M. Andrea, MD, Dominique Himbert, MD, Costanza Pellegrini, MD, Vincent Auffret, MD, Paolo Olivares, MD, Fabian Nietlispach, MD, Thomas Pilgrim, MD, Eric Durand, MD, John Lisko, MD, Raj Makkar, MD, Abdullah Alkhodair, MD, Lars Søndergaard, MD, Norman Mangner, MD, Lisa Crusius, MD, David Holzhey, MD, Ander Regueiro, MD and Josep Rodés-Cabau, MD David del ValDavid del Val Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (D.d.V., A.R., J.R.-C.). , Axel LinkeAxel Linke Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). University Hospital Carl Gustav Carus Dresden, Dresden, Germany (A. Linke, M.N.). , Mohamed Abdel-WahabMohamed Abdel-Wahab Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). Ospedale San Raffaele, Milan, Italy (A. Latib). , Azeem LatibAzeem Latib Ospedale San Raffaele, Milan, Italy (A. Latib). Montefiore Medical Center, New York (A. Latib). , Nikolaj IhlemannNikolaj Ihlemann Righospitalet, Copenhagen, Denmark (N.I., L.S.). , Marina UrenaMarina Urena Bichat Hôpital, Paris, France (M.U., D.H.). , Kim Won-KeunKim Won-Keun https://orcid.org/0000-0002-0799-7478 Kerckhoff Klinik, Bad Nauheim, Germany (K.W.-K.). , Oliver HusserOliver Husser DeutschesHerzzentrum München, Munich, Germany (O.H., C.P.). St.-Johannes-Hospital, Dortmund, Germany (O.H.). , Howard C. HerrmannHoward C. Herrmann https://orcid.org/0000-0003-3322-9568 Hospital of the University of Pennsylvania, Philadelphia (H.C.H.). , Luis Nombela-FrancoLuis Nombela-Franco https://orcid.org/0000-0003-3438-8907 Hospital Universitario Clinico San Carlos, Madrid, Spain (L.N.-F.). , Asim N. CheemaAsim N. Cheema St Michaels Hospital, Toronto, Canada (A.C.). Southlake Regional Health Centre, Newmarket, Canada (A.C.). , Hervé Le BretonHervé Le Breton Centre Hospitalier Universitaire de Rennes, Rennes, France (H.L.B., V.A.). , Stefan StorteckyStefan Stortecky https://orcid.org/0000-0002-5076-0177 Bern University Hospital (on behalf of Swiss Registry Centres), Bern, Switzerland (S.S., T.P.). , Antonio L. BartorelliAntonio L. Bartorelli Centro Cardiologico Monzino, Milan, Italy (A.B., P.O.). , Jan Malte SinningJan Malte Sinning University Hospital Bonn, Bonn, Germany (J.M.S.). , Ignacio Amat-SantosIgnacio Amat-Santos Hospital Clinico Universitario de Valladolid, Valladolid, Spain (I.A.-S.). , Antonio Munoz-GarciaAntonio Munoz-Garcia Hospital Universitario Virgen de la Victoria, Malaga, Spain (A.M.-G.). , Stamatios LerakisStamatios Lerakis https://orcid.org/0000-0001-7487-1990 Emory University School of Medicine, Atlanta, GA (S.L., J.L.). Mount Sinai Hospital, New York (S.L.). , Enrique Gutiérrez-IbanezEnrique Gutiérrez-Ibanez Hospital General Universitario Gregorio Maranon, Madrid, Spain (E.G.-I.). , Martin LandtMartin Landt Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., M.L.). , Didier TchetcheDidier Tchetche Clinique Pasteur, Toulouse, France (D.T.). , Luca TestaLuca Testa IRCCS Pol. San Donato, Milan, Italy (L.T.). , Helene EltchaninoffHelene Eltchaninoff Hôpital Charles-Nicolle,Rouen, France (H.E., E.D.). , Ugolino LiviUgolino Livi AOU Santa Maria della Misericordia, Udine, Italy (U.L.). , Juan Carlos CastilloJuan Carlos Castillo Hospital Universitario Reina Sofia, Cordoba, Spain (J.C.C.). , Tarun ChakravartyTarun Chakravarty Cedars-Sinai Heart Institute, Los Angeles, CA (T.C., R.M.). , John G. WebbJohn G. Webb St Paul's Hospital, Vancouver, Canada (J.G.W., A. Alkhodair). , Marco BarbantiMarco Barbanti Vittorio Emanuele Hospital, Catania, Italy (M.B.). , Susheel KodaliSusheel Kodali Columbia University Medical Center, New York, (S.K.). , Fabio S. de Brito JrFabio S. de Brito Jr Hospital Israelita Albert Einstein, Sao Paulo, Brazil (F.S.d.B.). , Henrique Barbosa RibeiroHenrique Barbosa Ribeiro Heart Institute (InCor) Sao Paulo, Brazil (H.R.). , Antonio MiceliAntonio Miceli Fondazione Toscana G. Monasterio, Massa, Italy (A.M.). , Claudia FiorinaClaudia Fiorina Spedali Civili di Brescia, Brescia, Italy (C.F.). , Guglielmo Mario Actis DatoGuglielmo Mario Actis Dato Ospedale Ordine Mauriziano di Torino, Torino, Italy (G.M.A.D.). , Francesco RosatoFrancesco Rosato https://orcid.org/0000-0001-6909-4998 S. Croce e Carle Cuneo, Cuneo, Italy (F.R.). , Vicenç SerraVicenç Serra Hospital Vall d'Hebron, Barcelona, Spain (V.S.). , Jean-Bernard MassonJean-Bernard Masson Centre Hospitalier de l'Universite de Montreal, Montreal, Canada (J.-B.M.). , Harindra C. WijeysunderaHarindra C. Wijeysundera https://orcid.org/0000-0001-8464-1080 Sunnybrook Health Science Center, Toronto, Canada (H.C.W.). , Jose A. MangioneJose A. Mangione https://orcid.org/0000-0002-4784-1152 Hospital Beneficencia Portuguesa, Sao Paulo, Brazil (J.A.M.). , Maria-Cristina FerreiraMaria-Cristina Ferreira Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil (M.-C.F.). , Valter Correa LimaValter Correa Lima Hospital Sao Francisco-Santa Clara, Porto Alegre, Brazil (V.C.L.). , Alexandre Siciliano ColafranceschiAlexandre Siciliano Colafranceschi https://orcid.org/0000-0003-0955-9225 Hospital Pró-cardíaco, Rio de Janeiro, Brazil (A.S.C.). , Alexandre AbizaidAlexandre Abizaid Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (A. Abizaid). , Marcos Antonio MarinoMarcos Antonio Marino Hospital Madre Teresa, Belo Horizonte, Brazil (M.A.M.). , Vinicius EstevesVinicius Esteves Hospital Sao Luiz, Sao Paulo, Brazil (V.E.). , Julio C.M. AndreaJulio C.M. Andrea Clínica Sao Vicente, Rio de Janeiro, Brazil (J.A.). , Dominique HimbertDominique Himbert https://orcid.org/0000-0002-0336-0058 Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). Bichat Hôpital, Paris, France (M.U., D.H.). , Costanza PellegriniCostanza Pellegrini DeutschesHerzzentrum München, Munich, Germany (O.H., C.P.). , Vincent AuffretVincent Auffret https://orcid.org/0000-0003-0535-2120 Centre Hospitalier Universitaire de Rennes, Rennes, France (H.L.B., V.A.). , Paolo OlivaresPaolo Olivares Centro Cardiologico Monzino, Milan, Italy (A.B., P.O.). , Fabian NietlispachFabian Nietlispach University Hospital Zurich, Zurich, Switzerland (F.N.). , Thomas PilgrimThomas Pilgrim https://orcid.org/0000-0001-8721-4068 Bern University Hospital (on behalf of Swiss Registry Centres), Bern, Switzerland (S.S., T.P.). , Eric DurandEric Durand Hôpital Charles-Nicolle,Rouen, France (H.E., E.D.). , John LiskoJohn Lisko Emory University School of Medicine, Atlanta, GA (S.L., J.L.). , Raj MakkarRaj Makkar Cedars-Sinai Heart Institute, Los Angeles, CA (T.C., R.M.). , Abdullah AlkhodairAbdullah Alkhodair St Paul's Hospital, Vancouver, Canada (J.G.W., A. Alkhodair). , Lars SøndergaardLars Søndergaard Righospitalet, Copenhagen, Denmark (N.I., L.S.). , Norman MangnerNorman Mangner https://orcid.org/0000-0001-8721-4068 Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). , Lisa CrusiusLisa Crusius Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). , David HolzheyDavid Holzhey Heart Center, Leipzig University, Leipzig, Germany (A. Linke, M.A.-W., M.N., L.C., D.H.). Bichat Hôpital, Paris, France (M.U., D.H.). , Ander RegueiroAnder Regueiro Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (D.d.V., A.R., J.R.-C.). Hospital Clinic de Barcelona, Barcelona, Spain (A.R.). and Josep Rodés-CabauJosep Rodés-Cabau Josep Rodés-Cabau, MD, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V 4GS, Quebec City, Quebec, Canada. Email E-mail Address: [email protected] https://orcid.org/0000-0001-8237-7095 Quebec Heart & Lung Institute, Laval University, Quebec City, Canada (D.d.V., A.R., J.R.-C.). Originally published12 Oct 2020https://doi.org/10.1161/CIRCULATIONAHA.120.047469Circulation. 2020;142:1497–1499Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare but life-threatening complication associated with a high rate of severe complications and in-hospital death.1–3 The high comorbidity burden of TAVR recipients along with an increased exposure to health care–associated procedures may explain, in part, the poorer clinical outcomes of this population. To date, most data on outcomes of IE after TAVR have been limited to short-term or midterm (1-year) follow-up.4 In this study, we sought to evaluate the long-term (>2 year) outcomes and prognostic factors in patients developing definite IE after TAVR who survived the index hospitalization.The Infective Endocarditis after TAVR International Registry collected data from 250 cases of definite IE (regardless of the structure involved) after TAVR (out of 20 006 patients undergoing TAVR; incidence: 1.1% per person-year) from 47 sites in Europe, North America, and South America between June 2005 and October 2015. The details and definitions of this registry have been previously reported.2 The incidence of in-hospital mortality was 36% (90 patients). The present study analyzed the patients who survived the index IE episode. Data on long-term outcomes were updated by each center between October 2018 and October 2019. The follow-up was complete in all patients but 5 (98%). All patients provided signed informed consent for the procedures, and the study was performed in accordance with the local ethics committee of each center. A multivariable Cox proportional hazards model was performed to determine the factors independently associated with mortality. The variables considered to be associated with late mortality and with a P value of <0.10 in the univariable analysis were included in the multivariable model. The proportional hazards assumption was tested by assessing log-minus-log survival plots and scaled Schoenfeld residuals. Survival at the 5-year follow-up was presented as Kaplan-Meier curves, and the Kaplan-Meier method was used to estimate the 5-year mortality incidence. Event times were measured from the date of initial IE symptoms to the date of death or last follow-up. Differences in the incidence of mortality were determined using the log-rank test. A 2-sided P value of 7 days (HRadj, 2.21 [1.21–4.03]; P=0.010). The Kaplan-Meier survival curves at 5-year follow-up for the global cohort and according to the presence of risk factors of late mortality are shown in the Figure. The presence of >2 risk factors was associated with a dreadful prognosis (mortality of 100% at 5 years).Download figureDownload PowerPointFigure. Kaplan-Meier estimate survival curves at 5-year follow-up of patients who survived the index IE hospitalization.A, Kaplan-Meier estimate survival curve at the 5-year follow-up of patients with IE after TAVR who survived the initial IE hospitalization. Kaplan-Meier estimate survival curve at the 5-year follow-up comparing patients with and without baseline chronic renal failure (B), fever as the initial symptom (C), IE-related complications (acute heart or renal failure and persistent bacteremia; D), involvement of TAVR prosthesis (E), and the presence of factors associated with long-term mortality (F). These risk factors included chronic renal failure at TAVR baseline, the absence of fever as initial symptom, new-onset heart or renal failure during IE hospitalization, persistent bacteremia, and IE without TAVR platform involvement. Time 0 represents the time of IE diagnosis. CRF indicates chronic renal failure; IE, infective endocarditis; RF, risk factors; and TAVR, transcatheter aortic valve replacement.The main limitations of this study are the potential bias on data collection inherent to retrospective studies and the lack of an independent event adjudication committee.In conclusion, patients who survived an initial IE episode after TAVR exhibited a poor prognosis, and about two-thirds of them had died at the 5-year follow-up. Chronic renal failure, IE characteristics (absence of fever, no TAVR prosthesis involvement), and the occurrence of IE-related complications determined an increased risk of late mortality. Late surgery during follow-up was low (<5%).Sources of FundingDrs del Val and Regueiro were supported by a research grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). Dr Rodés-Cabau holds the Research Chair "Fondation Famille Jacques Larivière" for the Development of Structural Heart Disease Interventions.DisclosuresThere was no specific funding for this work. Dr Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Tchetche has received consulting fees from Abbott Vascular, Boston Scientific, Edwards Lifesciencies, and Medtronic. Dr Webb has received consulting fees from Edwards Lifesciences and St. Jude Medical. Dr Makkar has received research grants from Edwards Lifesciences, Medtronic, Abbott, Capricor, and St. Jude Medical; has served as a proctor for Edwards Lifesciences; and has received consulting fees from Medtronic. Dr de Brito has received honoraria from Medtronic and Edwards Lifesciences for symposium speeches and proctoring cases. Dr Lerakis has received consulting fees from Edwards Lifesciences. Dr Nietlispach has received speaker and proctor fees from Abbott Vascular, Edwards Lifesciences, and Medtronic. The other authors report no conflicts.FootnotesThe data that support the findings of this study are available from the corresponding author on reasonable request.The full author list is available on page 1499.https://www.ahajournals.org/journal/circJosep Rodés-Cabau, MD, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V 4GS, Quebec City, Quebec, Canada. Email josep.[email protected]ulaval.caReferences1. Mangner N, Woitek F, Haussig S, Schlotter F, Stachel G, Höllriegel R, Wilde J, Lindner A, Holzhey D, Leontyev S, et al.. Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement.J Am Coll Cardiol. 2016; 67:2907–2908. doi: 10.1016/j.jacc.2016.03.588CrossrefMedlineGoogle Scholar2. Regueiro A, Linke A, Latib A, Ihlemann N, Urena M, Walther T, Husser O, Herrmann HC, Nombela-Franco L, Cheema AN, et al.. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death.JAMA. 2016; 316:1083–1092. doi: 10.1001/jama.2016.12347CrossrefMedlineGoogle Scholar3. Summers MR, Leon MB, Smith CR, Kodali SK, Thourani VH, Herrmann HC, Makkar RR, Pibarot P, Webb JG, Leipsic J, et al.. Prosthetic valve endocarditis after TAVR and SAVR: insights from the PARTNER trials.Circulation. 2019; 140:1984–1994. doi: 10.1161/CIRCULATIONAHA.119.041399LinkGoogle Scholar4. Harding D, Cahill TJ, Redwood SR, Prendergast BD. Infective endocarditis complicating transcatheter aortic valve implantation.Heart. 2020; 106:493–498. doi:10.1136/heartjnl-2019-315338CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 13, 2020Vol 142, Issue 15Article InformationMetrics Download: 230 © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.120.047469PMID: 33044863 Originally publishedOctober 12, 2020 Keywordsendocarditistreatment outcometranscatheter aortic valve replacementheart valve diseasesPDF download SubjectsAortic Valve Replacement/Transcatheter Aortic Valve ImplantationCatheter-Based Coronary and Valvular Interventions