Author + information
- Received October 24, 2018
- Revision received December 12, 2018
- Accepted December 30, 2018
- Published online April 1, 2019.
- Jawad H. Butt, MDa,∗ (, )@Rigshospitalet,
- Nikolaj Ihlemann, MD, PhDa,
- Ole De Backer, MD, PhDa,
- Lars Søndergaard, MD, DMSca,
- Eva Havers-Borgersen, MBa,
- Gunnar H. Gislason, MD, PhDb,c,d,
- Christian Torp-Pedersen, MD, DMSce,
- Lars Køber, MD, DMSca and
- Emil L. Fosbøl, MD, PhDa
- aDepartment of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- bDepartment of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
- cDepartment of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- dNational Institute of Public Health, University of Southern Denmark, Odense, Denmark
- eDepartment of Health Science and Technology, Aalborg University, Aalborg, Denmark
- ↵∗Address for correspondence:
Dr. Jawad H. Butt, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark.
Background Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.
Objectives This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.
Methods In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.
Results A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).
Conclusions The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.
Dr. De Backer has been a consultant for Abbott and Boston Scientific. Dr. Torp-Pedersen has received grants from Bayer and Biotronik; and has received personal fees from Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received October 24, 2018.
- Revision received December 12, 2018.
- Accepted December 30, 2018.
- 2019 American College of Cardiology Foundation
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