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Infective endocarditis after transcatheter aortic valve implantation: a nationwide study.
Bjursten, Henrik; Rasmussen, Magnus; Nozohoor, Shahab; Götberg, Mattias; Olaison, Lars; Rück, Andreas; Ragnarsson, Sigurdur.
Afiliação
  • Bjursten H; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
  • Rasmussen M; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
  • Nozohoor S; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
  • Götberg M; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
  • Olaison L; Department of Infectious Diseases, University of Gothenburg, Institute of Biomedicine, Gothenburg, Sweden.
  • Rück A; Department of Aortic Valve Disease, Karolinska University Hospital, Stockholm, Sweden.
  • Ragnarsson S; Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
Eur Heart J ; 40(39): 3263-3269, 2019 10 14.
Article em En | MEDLINE | ID: mdl-31433472
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/).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Próteses Valvulares Cardíacas / Infecções Relacionadas à Prótese / Endocardite / Substituição da Valva Aórtica Transcateter Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Eur Heart J Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Suécia

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Próteses Valvulares Cardíacas / Infecções Relacionadas à Prótese / Endocardite / Substituição da Valva Aórtica Transcateter Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Eur Heart J Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Suécia