Incidence, Predictors, and Outcomes of Endocarditis After Transcatheter Aortic Valve Replacement in the United States.

ABSTRACT

OBJECTIVES: This study sought to evaluate the incidence and outcomes of endocarditis after transcatheter aortic valve replacement (TAVR). BACKGROUND: Data about endocarditis after TAVR are limited. METHODS: The study investigated Medicare patients who underwent TAVR from 2012 to 2017 and identified patients admitted with endocarditis during follow-up using a validated algorithm. The main study outcome was all-cause mortality. RESULTS: Of 134,717 patients who underwent TAVR, 1868 patients developed endocarditis during follow-up (incidence 0.87%/year), with majority of infections (65.0%) occurring within 1 year. Incidence of endocarditis declined in recent years. The most common organisms were Staphylococcus (22.0%), Streptococcus (20.0%), and Enterococcus (15.5%). Important predictors for endocarditis were younger age at TAVR, male sex, prior endocarditis, end-stage renal disease, repeat TAVR procedures, liver and lung disease, and post-TAVR acute kidney injury. Thirty-day and 1-year mortality were 18.5% and 45.6%, respectively. After adjusting for comorbidities and procedural complications, endocarditis after TAVR was associated with 3-fold higher risk of mortality (44.9 vs. 16.2 deaths per 100 person-years; adjusted hazard ratio [aHR] 2.94; 95% confidence interval [CI] 2.77 to 3.12; p < 0.0001). End-stage renal disease (aHR 2.12; 95% CI 1.72 to 2.60), endocarditis complicated by cardiogenic shock (aHR 2.50, 95% CI 1.56 to 4.02), ischemic stroke (aHR 1.56; 95% CI 1.07 to 2.28), intracerebral hemorrhage (aHR 1.67; 95% CI 1.01 to 2.76), acute kidney injury (aHR 1.44; 95% CI 1.27 to 1.63), blood transfusion (aHR 1.28; 95% CI 1.09 to 1.50), staphylococcal (aHR 1.71; 95% CI 1.49 to 1.97), and fungal endocarditis (aHR 1.72; 95% CI 1.23 to 2.39) (p < 0.05 for all) portended higher mortality following endocarditis. CONCLUSIONS: The incidence of endocarditis after TAVR is low and declining. However, it is associated with poor prognosis with one-half the patients dying within 1 year.