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Very early infective endocarditis after transcatheter aortic valve replacement

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Abstract

Background

Scarce data exist about early infective endocarditis (IE) after trans-catheter aortic valve replacement (TAVR).

Objective

The objective was to evaluate the characteristics, management, and outcomes of very early (VE) IE (≤ 30 days) after TAVR.

Methods

This multicenter study included a total of 579 patients from the Infectious Endocarditis after TAVR International Registry who had the diagnosis of definite IE following TAVR.

Results

Ninety-one patients (15.7%) had VE-IE. Factors associated with VE-IE (vs. delayed IE (D-IE)) were female gender (p = 0.047), the use of self-expanding valves (p < 0.001), stroke (p = 0.019), and sepsis (p < 0.001) after TAVR. Staphylococcus aureus was the main pathogen among VE-IE patients (35.2% vs. 22.7% in the D-IE group, p = 0.012), and 31.2% of Staphylococcus aureus infections in the VE-IE group were methicillin-resistant (vs. 14.3% in the D-IE group, p = 0.001). The second-most common germ was enterococci (34.1% vs. 24.4% in D-IE cases, p = 0.05). VE-IE was associated with very high in-hospital (44%) and 1-year (54%) mortality rates. Acute renal failure following TAVR (p = 0.001) and the presence of a non-enterococci pathogen (p < 0.001) were associated with an increased risk of death.

Conclusion

A significant proportion of IE episodes following TAVR occurs within a few weeks following the procedure and are associated with dismal outcomes. Some baseline and TAVR procedural factors were associated with VE-IE, and Staphylococcus aureus and enterococci were the main causative pathogens. These results may help to select the more appropriate antibiotic prophylaxis in TAVR procedures and guide the initial antibiotic therapy in those cases with a clinical suspicion of IE.

Graphical abstract

Very early infective endocarditis after trans-catheter aortic valve replacement. VE-IE indicates very early infective endocarditis (≤30 days post TAVR). D-IE indicates delayed infective endocarditis.

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Abbreviations

D-IE:

Delayed infective endocarditis

IE:

Infective endocarditis

IQR:

Interquartile range

PVE:

Prosthetic valve endocarditis

TAVR:

Trans-catheter aortic valve replacement

THV:

Trans-catheter heart valve

VE-IE:

Very early infective endocarditis

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Acknowledgements

We would like to acknowledge the Infectious Endocarditis after TAVR International Registry Investigators for their substantial contribution to data collection and research (the list of investigators is available in the supplemental material). Dr Rodés-Cabau holds the Research Chair "Fondation Famille Jacques Larivière" for the Development of Structural Heart Disease Interventions. Dr. Panagides has received a research grant from the “Mediterranean Academic Research and Studies in Cardiology” association (MARS Cardio).

Funding

There was no specific funding for this study.

Author information

Authors and Affiliations

  1. Quebec Heart and Lung Institute, Laval University, Quebec City, Canada

    Vassili Panagides, Philippe Gervais, David del Val & Josep Rodés-Cabau

  2. Heart Center, Leipzig University, Leipzig, Germany

    Mohamed Abdel-Wahab, Norman Mangner, Axel Linke, Lisa Crusius, Holger Thiele & David Holzhey

  3. Heart Center, Segeberger Kliniken, Bad Segeberg, Germany

    Mohamed Abdel-Wahab & Martin Landt

  4. Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany

    Norman Mangner, Axel Linke & Lisa Crusius

  5. Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, 76000, Rouen, France

    Eric Durand & Helene Eltchaninoff

  6. Righospitalet, Copenhagen, Denmark

    Nikolaj Ihlemann & Lars Søndergaard

  7. Bichat Hôpital, Paris, France

    Marina Urena & Dominique Himbert

  8. Deutsches Herzzentrum München, Munich, Germany

    Costanza Pellegrini & Oliver Husser

  9. Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy

    Francesco Giannini & Azeem Latib

  10. Ospedale San Raffaele, Milan, Italy

    Francesco Giannini

  11. Department of Cardiology, Medical University of Warsaw, Warsaw, Poland

    Piotr Scislo & Zenon Huczek

  12. Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, 35000, Rennes, France

    Vincent Auffret & Hervé Le Breton

  13. Heart Center Bonn, Bonn, Germany

    Jan Malte Sinning

  14. St Michaels Hospital, Toronto, Canada

    Asim N. Cheema

  15. Southlake Hospital, Newmarket, ON, Canada

    Asim N. Cheema

  16. Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain

    Luis Nombela-Franco

  17. Hôpital Européen Georges-Pompidou, Paris, France

    Chekrallah Chamandi

  18. Hôpital Rangueil, Toulouse, France

    Francisco Campelo-Parada & Clement Servoz

  19. Hospital Universitario Virgen de la Victoria, Malaga, Spain

    Erika Munoz-Garcia

  20. Hospital of the University of Pennsilvania, Philadelphia, USA

    Howard C. Herrmann

  21. IRCCS Pol, San Donato, Milan, Italy

    Luca Testa

  22. Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

    Won-Keun Kim

  23. Augustinum Klinik München, München, Germany

    Oliver Husser

  24. Montefiore Medical Center, New York, NY, USA

    Azeem Latib

  25. Hospital Clínic Barcelona, Barcelona, Spain

    Josep Rodés-Cabau

Authors
  1. Vassili Panagides
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  2. Mohamed Abdel-Wahab
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  3. Norman Mangner
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  4. Eric Durand
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  5. Nikolaj Ihlemann
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  6. Marina Urena
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  7. Costanza Pellegrini
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  8. Francesco Giannini
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  10. Zenon Huczek
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  11. Martin Landt
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  12. Vincent Auffret
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  13. Jan Malte Sinning
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  14. Asim N. Cheema
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  18. Erika Munoz-Garcia
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  19. Howard C. Herrmann
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  20. Luca Testa
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  23. Lars Søndergaard
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  24. Dominique Himbert
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  25. Oliver Husser
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  26. Azeem Latib
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  27. Hervé Le Breton
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  28. Clement Servoz
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  29. Philippe Gervais
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  30. David del Val
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  31. Axel Linke
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  32. Lisa Crusius
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  33. Holger Thiele
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  34. David Holzhey
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  35. Josep Rodés-Cabau
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Corresponding author

Correspondence to Josep Rodés-Cabau.

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Conflict of interest

Josep Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. Vassili Panagides has received institutional research grants from Medtronic, Boston Scientific and Microport. C. Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic and consulting fees from Edwards Lifesciences and Medtronic. Jan Malte Sinning reports speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic and research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside the submitted work. Kim Won-Keun reports personal fees from Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, and Meril, outside the submitted work. Oliver Husser reports personal fees from Boston Scientific and payments from Abbott. Norman Mangner reports personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, and Bayer, outside the submitted work. All other authors report no potential conflicts.

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Panagides, V., Abdel-Wahab, M., Mangner, N. et al. Very early infective endocarditis after transcatheter aortic valve replacement. Clin Res Cardiol 111, 1087–1097 (2022). https://doi.org/10.1007/s00392-022-01998-0

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