Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.
Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).



To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.



The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.



Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.



Infective endocarditis and in-hospital mortality after infective endocarditis.



A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).



Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Ander
A
Regueiro
Heart Center, Leipzig University, Leipzig, Germany.
Axel
A
Linke
EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
Azeem
A
Latib
Rigshospitalet, Copenhagen, Denmark.
Nikolaj
N
Ihlemann
Bichat Hôpital, AP-HP, University Paris Diderot, France.
Marina
M
Urena
Kerckhoff Klinik, Bad Nauheim, Germany.
Thomas
T
Walther
Deutsches Herzzentrum München, Technische Universität München, DZHK, partner site Munich Heart Alliance, Munich, Germany.
Oliver
O
Husser
Hospital of the University of Pennsylvania, Philadelphia.
Howard C
HC
Herrmann
Hospital Universitario Clinico San Carlos, Madrid, Spain.
Luis
L
Nombela-Franco
St Michaels Hospital, Toronto, Canada.
Asim N
AN
Cheema
Centre Hospitalier Universitaire de Rennes, Rennes, France.
Hervé
H
Le Breton
Bern University Hospital (on behalf of Swiss TAVI Registry Centres), Bern, Switzerland.
Stefan
S
Stortecky
Cleveland Clinic, Cleveland, Ohio.
Samir
S
Kapadia
Centro Cardiologico Monzino, Milan, Italy.
Antonio L
AL
Bartorelli
Heart Center Bonn, Bonn, Germany.
Jan Malte
JM
Sinning
Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
Ignacio
I
Amat-Santos
Hospital Universitario Virgen de la Victoria, Malaga, Spain.
Antonio
A
Munoz-Garcia
Emory University School of Medicine, Atlanta, Georgia.
Stamatios
S
Lerakis
Hospital Gregorio Maranon, Madrid, Spain.
Enrique
E
Gutiérrez-Ibanes
Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
Mohamed
M
Abdel-Wahab
Clinique Pasteur, Toulouse, France.
Didier
D
Tchetche
IRCCS Pol. San Donato, Milan, Italy.
Luca
L
Testa
Hôpital Charles Nicolle, University of Rouen, INSERM U1096, France.
Helene
H
Eltchaninoff
Department of Cardiothoracic Surgery, University Hospital of Udine, Italy.
Ugolino
U
Livi
Hospital Universitario Reina Sofia, Cordoba, Spain.
Juan Carlos
JC
Castillo
Cedars-Sinai Heart Institute, Los Angeles, California.
Hasan
H
Jilaihawi
St Pauls Hospital, Vancouver, British Columbia, Canada.
John G
JG
Webb
Ferrarotto Hospital, Catania, Italy.
Marco
M
Barbanti
Columbia University Medical Center, New York, New York.
Susheel
S
Kodali
Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Fabio S
FS
de Brito
Heart Institute (InCor), Sao Paulo, Brazil.
Henrique B
HB
Ribeiro
Fondazione Toscana G. Monasterio, Massa, Italy.
Antonio
A
Miceli
Spedali Civili di Brescia, Brescia, Italy.
Claudia
C
Fiorina
Ospedale Mauriziano, Torino, Italy.
Guglielmo Mario Actis
GM
Dato
Azienda Ospedaliera, S. Croce e Carle Cuneo, Cuneo, Italy.
Francesco
F
Rosato
Hospital Vall d'Hebron, Barcelona, Spain.
Vicenç
V
Serra
Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
Jean-Bernard
JB
Masson
Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
Harindra C
HC
Wijeysundera
Hospital Beneficencia Portuguesa, Sao Paulo, Brazil.
Jose A
JA
Mangione
Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.
Maria-Cristina
MC
Ferreira
Hospital São Francisco-Santa Casa de Misericórdia de Porto Alegre, Brazil.
Valter C
VC
Lima
Hospital Pró-cardíaco, Rio de Janeiro, Brazil.
Luiz A
LA
Carvalho
Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
Alexandre
A
Abizaid
Hospital Madre Teresa, Belo Horizonte, Brazil.
Marcos A
MA
Marino
Hospital Sao Luiz, Sao Paulo, Brazil.
Vinicius
V
Esteves
Clínica Sao Vicente, Rio de Janeiro, Brazil.
Julio C M
JC
Andrea
EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy.
Francesco
F
Giannini
Bichat Hôpital, AP-HP, University Paris Diderot, France.
David
D
Messika-Zeitoun
Bichat Hôpital, AP-HP, University Paris Diderot, France.
Dominique
D
Himbert
Kerckhoff Klinik, Bad Nauheim, Germany.
Won-Keun
WK
Kim
Deutsches Herzzentrum München, Technische Universität München, DZHK, partner site Munich Heart Alliance, Munich, Germany.
Costanza
C
Pellegrini
Centre Hospitalier Universitaire de Rennes, Rennes, France.
Vincent
V
Auffret
University Hospital Zurich, Zurich, Switzerland.
Fabian
F
Nietlispach
Bern University Hospital (on behalf of Swiss TAVI Registry Centres), Bern, Switzerland.
Thomas
T
Pilgrim
Hôpital Charles Nicolle, University of Rouen, INSERM U1096, France.
Eric
E
Durand
Emory University School of Medicine, Atlanta, Georgia.
John
J
Lisko
Cedars-Sinai Heart Institute, Los Angeles, California.
Raj R
RR
Makkar
Heart Institute (InCor), Sao Paulo, Brazil.
Pedro A
PA
Lemos
Columbia University Medical Center, New York, New York.
Martin B
MB
Leon
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Rishi
R
Puri
Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
Alberto
A
San Roman
Bichat Hôpital, AP-HP, University Paris Diderot, France.
Alec
A
Vahanian
Rigshospitalet, Copenhagen, Denmark.
Lars
L
Søndergaard
Heart Center, Leipzig University, Leipzig, Germany.
Norman
N
Mangner
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Josep
J
Rodés-Cabau
D000367:Age Factors; D000368:Aged; D004696:Endocarditis / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D013211:Staphylococcus aureus; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome