Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement.
Clin Infect Dis
; 75(4): 638-646, 2022 09 10.
Article
en En
| MEDLINE
| ID: mdl-34894124
ABSTRACT
BACKGROUND:
Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.METHODS:
This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula.RESULTS:
A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI] 1.27-3.41; Pâ =â .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI 1.57-4.69; Pâ <â .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, Pâ <â .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padjâ <â 0.05 for all).CONCLUSIONS:
PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Aneurisma Falso
/
Endocarditis
/
Endocarditis Bacteriana
/
Insuficiencia Renal Crónica
/
Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Clin Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
Año:
2022
Tipo del documento:
Article
País de afiliación:
Canadá