Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
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, Won-Keun Kim, 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
OBJECTIVES: The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization.
METHODS: Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]).
RESULTS: A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47).
CONCLUSIONS: Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.