Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement

BACKGROUND: Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS: Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS: Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE (CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS: Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

L'enquete narrative : entre description du vecu et configuration biographique / Narrative research: between the description of lived experience and biographical configuration / La investigación narrativa: entre la descripción de la experiencia vivida y la configuración biográfica / Pesquisa narrativa: entre descrição da experiência vivida e configuração biográfica

Résumé L'enquête narrative a pour spécificité de chercher à comprendre le vécu du sujet en mobilisant des récits d'expérience « en première personne ¼. Elle vise l'appréhension et la compréhension des processus d'édification des « points de vue ¼ à partir d'une activité narrative qui suppose deux passages : celui de l'expérience au langage (soit la mise en mots du vécu), celui du texte à l'histoire (soit la configuration biographique du récit). L'activité narrative par laquelle procède cette forme d'enquête suppose d'effectuer des actes qui rendent possible son accomplissement. L'enjeu de cet article est de caractériser ces régimes narratifs, d'en formaliser les procédés, et de spécifier les types d'effets générés sur les processus de compréhension, de formation de soi et de constitution de connaissances.

Abstract Narrative research seeks to understand the subject's experience using life stories "in the first person" by apprehending and understanding the process of construction of "points of view" in a narrative activity that implies passing from experience into language and from text into story, assuming the performance of acts that render this possible. Based on Ricœur's thesis of the principle of reciprocity between the temporalization of experience and the configuration of narrative, we distinguish between two narrative regimes: the biographical one and the one pertaining to phenomenological description. We seek to describe both regimes, formalize their processes and specify their effects in order to define the narrative regimes and examine their effects on adult education and on humanities research.

Resumen La investigación narrativa intenta comprender la experiencia del sujeto utilizando historias de vida "en primera persona" por medio de la aprehensión y comprensión del proceso de construcción de "puntos de vista" en una actividad narrativa que presupone pasos de la experiencia al lenguaje y del texto a la historia, suponiendo la realización de actos que lo hagan posible. En base a la tesis de Ricoeur del principio de reciprocidad entre la temporalización de la experiencia y la configuración de la narrativa, se distinguen dos regímenes narrativos: el biográfico y el de descripción fenomenológica. Se trata de caracterizar dichos regímenes, formalizar sus procesos y especificar sus efectos, produciendo un trabajo de definición de regímenes narrativos y examinando sus efectos en la educación de adultos y en la investigación en ciencias humanas.

Resumo A pesquisa narrativa procura compreender a experiência do sujeito, utilizando histórias de vida "em primeira pessoa" pela apreensão e compreensão do processo de construção de "pontos de vista" em uma atividade narrativa que supõe passagens da experiência à linguagem e do texto à história, pressupondo a realização de atos que o possibilitem. Com base na tese de Ricœur do princípio da reciprocidade entre a temporalização da experiência e a configuração da narrativa, distingue-se dois regimes narrativos: o biográfico e o de descrição fenomenológica. Busca-se caracterizar esses regimes, formalizar seus processos e especificar seus efeitos, produzindo um trabalho de definição de regimes narrativos e examinando seus efeitos na educação de adultos e na pesquisa em ciências humanas.

Infective endocarditis following transcatheter aortic valve replacement: comparison of balloon- versus self-expandable valves

BACKGROUND: No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. METHODS: Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. RESULTS: A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2-15] months versus BEV, 5.3 [1.7-11.4] months; P=0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P<0.01), and vegetation location differed according to valve type (stent frame, SEV, 18.6%; BEV, 6.9%; P=0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P=0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04-5.82, P=0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P=0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P=0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died (P=0.66). CONCLUSIONS: The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field. (AU)

Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death

IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients...

Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography.

This paper reports on a method for left ventricle three-dimensional (3-D) reconstruction from two orthogonal ventriculograms. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as to match the input projections. To this end, the object is modeled as a 3-D Markov-Gibbs random field, and an energy function is defined so that it includes one term that models the projections compatibility and another one that includes the space-time regularity constraints. The performance of this reconstruction method is evaluated by considering the reconstruction of mathematically synthesized phantoms and two 3-D binary databases from two orthogonal synthesized projections. The method is also tested using real biplane ventriculograms. In this case, the performance of the reconstruction is expressed in terms of the projection error, which attains values between 9.50% and 11.78 % for two biplane sequences including a total of 55 images.