Infective endocarditis after TAVR tied to mortality, stroke risks

Infective endocarditis after transcatheter aortic valve replacement (TAVR) is commonly caused by Enterococcus species and usually occurs during the early period, reveals a study. It is also associated with significant risks of mortality and stroke.

A total of 7,203 patients underwent TAVR at 15 hospitals in Switzerland during the observational period. Of these, 149 patients had endocarditis during follow-up of 14,832 patient-years. Peri-procedural endocarditis after TAVR had the highest incidence at 2.59 events per 100 person-years, followed by delayed-early and late endocarditis with 0.71 and 0.40 events per 100 person-years, respectively.

The most frequently isolated microorganism among patients with early endocarditis was Enterococcus species (30.1 percent). Among those with peri-procedural endocarditis, 47.9 percent had a pathogen that was not susceptible to the peri-procedural antibiotic prophylaxis.

The following factors correlated independently with endocarditis: younger age (subhazard ratio [SHR], 0.969, 95 percent confidence interval [CI], 0.944–0.994), male sex (SHR, 1.989, 95 percent CI, 1.403–2.818), lack of predilatation (SHR, 1.485, 95 percent CI, 1.065–2.069), and treatment in a catheterization laboratory as opposed to hybrid operating room (SHR, 1.648, 95 percent CI, 1.187–2.287).

Of note, the risks of mortality (HR, 6.55, 95 percent CI, 4.44–9.67) and stroke (HR, 4.03, 95 percent CI, 1.54–10.52) were increased in patients with endocarditis, according to the results of a case-control matched analysis.

This study included consecutive patients from the SwissTAVI Registry between February 2011 and July 2018. Infective endocarditis was classified into early (peri-procedural [<100 days] and delayed-early [100 days to 1 year]) and late (>1 year) endocarditis. The authors assessed clinical events according to the Valve Academic Research Consortium-2 endpoint definitions.