Study Details Risk Factors for Post-TAVR Infective Endocarditis

A new retrospective study has identified multiple risk factors for infective endocarditis after transcatheter aortic valve replacement (TAVR).

In their study, the authors set out to determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.
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The investigators analyzed data from the Infectious Endocarditis after TAVR International Registry, which included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. Main outcomes and measures were infective endocarditis and in-hospital mortality after infective endocarditis.

Overall, a total of 250 cases of infective endocarditis occurred in 20,006 patients after TAVR, an incidence rate of 1.1% per person-year. The median time from TAVR to infective endocarditis was 5.3 months, and the characteristics associated with higher risk of progressing to infective endocarditis after TAVR were younger age, male sex, diabetes mellitus, and moderate to severe aortic regurgitation.

In addition, health care–associated infective endocarditis was present in 52.8% of patients. Enterococcus species and Staphylococcus aureus were the most frequently isolated microorganisms. The in-hospital mortality rate was 36%, and surgery was performed in 14.8% of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE, heart failure, and acute kidney injury. The 2-year mortality rate was 66.7%.

"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," wrote the authors, adding that "patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality."

—Mark McGraw

Reference:

Reguiero A, Linke A, Latib A, et al. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA. 2016;316(10):1083-1092.