Very early infective endocarditis after transcatheter aortic valve replacement

Clinical Research in Cardiology - Tập 111 - Trang 1087-1097 - 2022
Vassili Panagides1, Mohamed Abdel-Wahab2,3, Norman Mangner2,4, Eric Durand5, Nikolaj Ihlemann6, Marina Urena7, Costanza Pellegrini8, Francesco Giannini9,10, Piotr Scislo11, Zenon Huczek11, Martin Landt3, Vincent Auffret12, Jan Malte Sinning13, Asim N. Cheema14,15, Luis Nombela-Franco16, Chekrallah Chamandi17, Francisco Campelo-Parada18, Erika Munoz-Garcia19, Howard C. Herrmann20, Luca Testa21, Won-Keun Kim22, Helene Eltchaninoff5, Lars Søndergaard6, Dominique Himbert7, Oliver Husser8,23, Azeem Latib9,24, Hervé Le Breton12, Clement Servoz18, Philippe Gervais1, David del Val1, Axel Linke2,4, Lisa Crusius2,4, Holger Thiele2, David Holzhey2, Josep Rodés-Cabau1,25
1Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
2Heart Center, Leipzig University, Leipzig, Germany
3Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
4Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
5Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
6Righospitalet, Copenhagen, Denmark
7Bichat Hôpital, Paris, France
8Deutsches Herzzentrum München, Munich, Germany
9Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
10Ospedale San Raffaele, Milan, Italy
11Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
12Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France
13Heart Center Bonn, Bonn, Germany
14St Michaels Hospital, Toronto, Canada
15Southlake Hospital, Newmarket, Canada
16Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
17Hôpital Européen Georges Pompidou, Paris, France
18Hôpital Rangueil, Toulouse, France
19Hospital Universitario Virgen de la Victoria, Malaga, Spain
20Hospital of the University of Pennsilvania, Philadelphia, USA
21IRCCS Pol, Milan, Italy
22Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
23Augustinum Klinik München, München, Germany
24Montefiore Medical Center, New York, USA
25Hospital Clínic Barcelona, Barcelona, Spain

Tóm tắt

Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR). The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR. This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR. Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death. A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE. Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.

Tài liệu tham khảo

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