Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation.
J Am Coll Cardiol
; 79(8): 772-785, 2022 03 01.
Article
in En
| MEDLINE
| ID: mdl-35210032
ABSTRACT
BACKGROUND:
The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain.OBJECTIVES:
The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB).METHODS:
Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry.RESULTS:
Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj 0.85; 95% CI 0.58-1.25) and 1-year all-cause mortality (HRunadj 0.88; 95% CI 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj 0.92; 95% CI 0.80-1.05) and 1-year all-cause mortality (HRadj 0.95; 95% CI 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock.CONCLUSIONS:
In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Staphylococcal Infections
/
Prosthesis-Related Infections
/
Endocarditis, Bacterial
/
Transcatheter Aortic Valve Replacement
Type of study:
Etiology_studies
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
J Am Coll Cardiol
Year:
2022
Type:
Article