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Predictive factors and long-term prognosis of transcatheter aortic valve implantation-associated endocarditis

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Abstract

Background

There are still limited data regarding transcatheter aortic valve implantation (TAVI) endocarditis.

Objectives

The objective of the present study was to investigate the predictor and long-term outcome of TAVI endocarditis.

Methods

Consecutive patients undergoing TAVI at the University of Bonn were prospectively enrolled in this study. Transcatheter heart valve (THV) endocarditis was defined according to Duke criteria. The primary outcome was all-cause death within a 5-year follow-up.

Results

1448 successful TAVI patients were eligible for the study and 17 patients (1.2%) developed THV endocarditis during the follow-up period (median 294 days). A multivariable logistic regression analysis identified age (odds ratio [OR] 0.90; P = 0.001) and residual paravalvular leakage (PVL) ≥ 2 after TAVI (OR 5.15; P = 0.015) as the main predictors for the occurrence of TAVI endocarditis. Additional analyses revealed that younger patients were significantly associated with higher rates of diabetes (P = 0.001), hemodialysis (P < 0.001), prior cardiac surgery (P < 0.001), and chronic obstructive pulmonary disease (COPD) (P < 0.001). A Kaplan–Meier analysis showed a significantly worse prognosis in TAVI patients with endocarditis than in patients without (log-rank; P = 0.03) during the 5-year follow-up. A multivariable Cox proportional hazard analysis revealed that TAVI endocarditis is an independent predictor of long-term mortality (hazard ratio 4.17; 95% CI 1.91–9.07; P < 0.001).

Conclusions

Our study identified lower age and residual PVL ≥ 2 as predictors for THV endocarditis, which itself may be considered as an independent predictor of long-term mortality after TAVI.

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Acknowledgements

We thank Ms. Meghan Campbell, a scientific coordinator in the Heart Center Bonn, for proofreading the manuscript.

Funding

Dr. Tabata was supported financially in part by a Fellowship from the Astellas Foundation for Research on Metabolic Disorders and the Uehara Memorial Foundation.

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Authors and Affiliations

  1. Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany

    Noriaki Tabata, Baravan Al-Kassou, Atsushi Sugiura, Jasmin Shamekhi, Alexander Sedaghat, Nikos Werner, Eberhard Grube, Georg Nickenig & Jan-Malte Sinning

  2. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Noriaki Tabata & Kenichi Tsujita

  3. Department of Cardiothoracic Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany

    Hendrik Treede

Authors
  1. Noriaki Tabata
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  2. Baravan Al-Kassou
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Correspondence to Jan-Malte Sinning.

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Conflict of interest

Drs. Sinning, Werner, and Nickenig have received speaker honoraria and research grants from Abbott, Abiomed, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Tsujita has received grants from Abbott Vascular Japan, Medtronic Japan, and Boston Scientific Japan. The other authors report no conflict of interest.

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Tabata, N., Al-Kassou, B., Sugiura, A. et al. Predictive factors and long-term prognosis of transcatheter aortic valve implantation-associated endocarditis. Clin Res Cardiol 109, 1165–1176 (2020). https://doi.org/10.1007/s00392-020-01609-w

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  • DOI: https://doi.org/10.1007/s00392-020-01609-w

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