Stroke not uncommon in patients with infective endocarditis post-TAVR

One in 10 patients with infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) suffer a stroke, reports a study. Stroke history, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation are associated with an increased risk.

In addition, “[t]he occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes,” the authors said.

This study analysed data from the Infectious Endocarditis after TAVR International Registry, including 569 patients who developed definite IE following TAVR from 59 centres in 11 countries. Patients were grouped into two according to stroke occurrence during IE admission: stroke (S-IE) vs no stroke (NS-IE).

Of the participants, 57 (10 percent) had a stroke during IE hospitalization, with no differences in causative micro-organism between groups. S-IE patients had higher rates of acute renal failure, systemic embolization, and persistent bacteraemia (p<0.05 for all) than NS-IE patients.

The following factors correlated with an increased stroke risk during index IE hospitalization: previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm (p<0.05 for all). Stroke rate was 3.1 percent in patients with no risk factors and rose to 60 percent in the presence of more than three risk factors.

At 1 year, S-IE vs NS-IE patients showed higher rates of in-hospital mortality (54.4 percent vs 28.7 percent; p<0.001) and overall mortality (66.3 percent vs 45.6 percent; p<0.001).

Additionally, surgical treatment did not improve outcomes in S-IE patients (in-hospital mortality in surgical vs no surgical treatment: 46.2 percent vs 58.1 percent; p=0.47).