title: Early, intermediate and late infectious complications after transcatheter or surgical aortic-valve replacement: a prospective cohort study.
abstract: Transcatheter aortic valve implantation (TAVI) has been proposed to treat older surgical high-risk patients with severe symptomatic aortic stenosis. There are no data regarding short-term and long-term infectious complications in these patients. The objective of this study was to define the incidence, aetiology and outcome of early and late infectious complications following TAVI compared with patients >65 years old undergoing traditional surgical aortic replacement (SAR). This was a prospective observational study evaluating all consecutive patients who underwent TAVI or SAR. Follow up was performed up to 1 year after the procedure of valve implantation. Fifty-one patients underwent TAVI and were compared with 102 patients who underwent SAR. Compared with SAR patients, those who underwent TAVI had lower incidence of early post-operative (11.7% vs 26.4%, p 0.04), intermediate (5.9% vs 17.6%, p 0.01) and late (7.8% vs 11.7%, p 0.03) infections. Among SAR patients the most common infections were bloodstream infections, pneumonias, urinary tract infections and sternal wound infections. Patients who underwent TAVI had a longer survival without infection (358 days vs 312.9, p 0.006). There were no significant differences in 12-month crude survival between the two study populations. Despite a high frequency of coexisting illnesses, patients undergoing TAVI develop few infectious complications. TAVI appears to be a reasonable and safe option in high-risk patients with severe symptomatic aortic stenosis.
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Falcone
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.forename: M
authors.initials: M
authors.lastname: Mancone
authors.forename: G
authors.initials: G
authors.lastname: Carriero
authors.forename: G
authors.initials: G
authors.lastname: Mazzesi
authors.forename: F
authors.initials: F
authors.lastname: Miraldi
authors.forename: M
authors.initials: M
authors.lastname: Pennacchi
authors.forename: F
authors.initials: F
authors.lastname: Pugliese
authors.forename: L
authors.initials: L
authors.lastname: Tritapepe
authors.forename: V
authors.initials: V
authors.lastname: Vullo
authors.forename: F
authors.initials: F
authors.lastname: Fedele
authors.forename: G
authors.initials: G
authors.lastname: Sardella
authors.forename: M
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis
keywords: Septic shock; severe aortic stenosis; staphylococcal infections; surgical valve replacement; transcatheter aortic valve implantation