title: Prosthetic valve endocarditis after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural risk factors.
  
  
  RESULTS
  Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years (interquartile range, 0.5-2.5 years; longest follow-up was 6.3 years). TAVI-PVE was most frequent in the first year after implantation (first-year incidence, 3.1% [confidence interval, 1.4%-4.8%]); the overall annualized rate was 2.1% per patient-year (confidence interval, 1.2%-3.3%). Seventeen patients (94%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate or worse postprocedural paravalvular regurgitation (hazard ratio, 4.0 [1.5-11]), implantation of >1 prosthesis (hazard ratio, 5.2 [1.5-18]), and any vascular complication (hazard ratio, 3.8 [1.5-9.8]).
  
  
  CONCLUSIONS
  TAVI-PVE occurred at a slightly higher rate than reported for surgically implanted valves. Conservative treatment was associated with an acceptable outcome. Suboptimal valve deployment and vascular complications were associated with an increased risk of TAVI-PVE.
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark. niels.thue.olsen.01@regionh.dk.
authors: Niels Thue
authors: NT
authors: Olsen
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Ole
authors: O
authors: De Backer
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Hans G H
authors: HG
authors: Thyregod
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Niels
authors: N
authors: Vejlstrup
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Henning
authors: H
authors: Bundgaard
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Søndergaard
authors: From the Department of Cardiology (N.T.O., O.D.B., N.V., H.B., L.S., N.I.), Department of Cardiothoracic Surgery (H.G.H.T.), Rigshospitalet, Copenhagen, Denmark.
authors: Nikolaj
authors: N
authors: Ihlemann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003718:Denmark; D059905:Endocarditis, Non-Infective / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: endocarditis; transcatheter aortic valve replacement