Perivalvular Extension of Infective Endocarditis After Transcatheter Aortic Valve Replacement.
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Panagides Vassili, Del Val David, Abdel-Wahab Mohamed, Mangner Norman, Durand Eric, Ihlemann Nikolaj, Urena Marina, Pellegrini Costanza, Giannini Francesco, Gasior Tomasz, Wojakowski Wojtek, Landt Martin, Auffret Vincent, Sinning Jan Malte, Cheema Asim N, Nombela-Franco Luis, Chamandi Chekrallah, Campelo-Parada Francisco, Munoz-Garcia Erika, Herrmann Howard C, Testa Luca, Kim Won Keun, Castillo Juan Carlos, Alperi Alberto, Tchetche Didier, Bartorelli Antonio L, Kapadia Samir, Stortecky Stefan, Amat-Santos Ignacio, Wijeysundera Harindra C, Lisko John, Gutiérrez-Ibanes Enrique, Serra Vicenç, Salido Luisa, Alkhodair Abdullah, Livi Ugolino, Chakravarty Tarun, Lerakis Stamatios, Vilalta Victoria, Regueiro Ander, Romaguera Rafael, Kappert Utz, Barbanti Marco, Masson Jean Bernard, Maes Frédéric, Fiorina Claudia, Miceli Antonio, Kodali Susheel, Ribeiro Henrique B, Mangione Jose Armando, Sandoli de Brito Fabio, Actis Dato Guglielmo Mario, Rosato Francesco, Ferreira Maria Cristina, Correia de Lima Valter, Colafranceschi Alexandre Siciliano, Abizaid Alexandre, Marino Marcos Antonio, Esteves Vinicius, Andrea Julio, Godinho Roger R, Alfonso Fernando, Eltchaninoff Helene, Søndergaard Lars, Himbert Dominique, Husser Oliver, Latib Azeem, Le Breton Hervé, Servoz Clement, Pascual Isaac, Siddiqui Saif, Olivares Paolo, Hernandez-Antolin Rosana, Webb John G, Sponga Sandro, Makkar Raj, Kini Annapoorna S, Boukhris Marouane, Gervais Philippe, Linke Axel, Crusius Lisa, Holzhey David, Rodés-Cabau Josep
Аннотация
METHODS: This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula.
RESULTS: A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27-3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57-4.69; P < .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, P < .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj < 0.05 for all).
CONCLUSIONS: PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.