Infective endocarditis does not bode well for patients after transcatheter aortic valve replacement (TAVR), according to a single-center study.
Infective endocarditis was recorded in 3.02% of patients over a median of about 1 year after the procedure, for a rate of 1.82% per patient-year, Norman Mangner, MD, of Germany’s University of Leipzig — Heart Center Leipzig, and colleagues reported online in the Journal of the American College of Cardiology.
Of those diagnosed with the infection, 63.6% died in the hospital after a median of 28 days and 74.5% had died by 1 year.
Mortality was tied to chronic hemodialysis (HR 8.60, 95% CI 2.15-34.44), heart failure (HR 2.77, 95% CI 1.20-6.39), and sepsis or septic shock (HR 5.50, 95% CI 2.18-13.85).
“Infective endocarditis-related complications such as heart failure and sepsis predicted in-hospital death, suggesting an early and aggressive therapy approach (e.g., surgery) may improve outcome,” the researchers wrote. “Patients requiring chronic hemodialysis remain the highest risk group for both development of and death by infective endocarditis after transfemoral TAVR.”
Independent predictors for developing infective endocarditis were chronic hemodialysis (hazard ratio 8.37, 95% CI 2.54-27.63) and peripheral artery disease (HR 3.77, 95% CI 1.88-7.58).
The source of the bacteria was possibly identified in 77.3% of patients, with 41.8% of cases described as hospital-acquired infective endocarditis. The most common culprit bacteria were coagulase-positive staphylococci (38.2% of cases) and enterococci.
“This highlights the need for preventive and aseptic techniques during health care procedures in these high-risk patients,” the authors suggested.
Most patients (83.6%) were given antibiotics as the sole treatment. Only 16.4% underwent surgery, even though about two-thirds (64.8%) had at least one indication for an invasive procedure, such as heart failure (37%), sepsis or septic shock (40.7%), or systemic embolism (21.8%).
“Treatment of infective endocarditis was a conservative approach in most patients, with a minority also undergoing surgery despite a high rate of potential indications for surgery,” Mangner’s group noted.
Mangner’s investigation included records of 1,820 patients who got TAVR with a transfemoral approach at a single center.
Infective endocarditis was diagnosed in 74.5% within 12 months of TAVR, with the remaining 25.5% of cases emerging later at a median of 628 days.
Journal of the American College of Cardiology
Mangner N, et al “Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcathter aortic valve replacement” J Am Coll Cardiol 2016; DOI: 10.1016/j.jacc.2016.03.588.