Author + information
- Received December 30, 2019
- Revision received April 16, 2020
- Accepted April 17, 2020
- Published online June 15, 2020.
- Stefan Stortecky, MDa,
- Dik Heg, PhDb,
- David Tueller, MDc,
- Thomas Pilgrim, MDa,
- Olivier Muller, MDd,
- Stephane Noble, MDe,
- Raban Jeger, MDf,
- Stefan Toggweiler, MDg,
- Enrico Ferrari, MDh,
- Maurizio Taramasso, MDi,
- Francesco Maisano, MDi,
- Rebeca Hoeller, MDa,
- Peter Wenaweser, MDj,
- Fabian Nietlispach, MDk,
- Andreas Widmer, MDl,
- Christoph Huber, MDe,
- Marco Roffi, MDe,
- Thierry Carrel, MDa,
- Stephan Windecker, MDa,∗ ( and )
- Anna Conen, MDm
- aDepartment of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- bDepartment of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- cDepartment of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
- dDepartment of Cardiology, Lausanne University Hospital–CHUV, Lausanne, Switzerland
- eDivision of Cardiology and Cardiovascular Surgery, University Hospital, Geneva, Switzerland
- fDepartment of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland
- gCantonal Hospital Lucerne, Lucerne, Switzerland
- hDepartment of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
- iDepartment of Cardiovascular Surgery, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
- jHeart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland
- kCardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
- lDepartment of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- mDepartment of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
- ↵∗Address for correspondence:
Dr. Stephan Windecker, Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland.
Background Infective endocarditis may affect patients after transcatheter aortic valve replacement (TAVR).
Objectives The purpose of this study was to provide detailed information on incidence rates, types of microorganisms, and outcomes of infective endocarditis after TAVR.
Methods Between February 2011 and July 2018, consecutive patients from the SwissTAVI Registry were eligible. Infective endocarditis was classified into early (peri-procedural [<100 days] and delayed-early [100 days to 1 year]) and late (>1 year) endocarditis. Clinical events were adjudicated according to the Valve Academic Research Consortium-2 endpoint definitions.
Results During the observational period, 7,203 patients underwent TAVR at 15 hospitals in Switzerland. During follow-up of 14,832 patient-years, endocarditis occurred in 149 patients. The incidence for peri-procedural, delayed-early, and late endocarditis after TAVR was 2.59, 0.71, and 0.40 events per 100 person-years, respectively. Among patients with early endocarditis, Enterococcus species were the most frequently isolated microorganisms (30.1%). Among those with peri-procedural endocarditis, 47.9% of patients had a pathogen that was not susceptible to the peri-procedural antibiotic prophylaxis. Younger age (subhazard ratio [SHR]: 0.969; 95% confidence interval [CI]: 0.944 to 0.994), male sex (SHR: 1.989; 95% CI: 1.403 to 2.818), lack of pre-dilatation (SHR: 1.485; 95% CI: 1.065 to 2.069), and treatment in a catheterization laboratory as opposed to hybrid operating room (SHR: 1.648; 95% CI: 1.187 to 2.287) were independently associated with endocarditis. In a case-control matched analysis, patients with endocarditis were at increased risk of mortality (hazard ratio: 6.55; 95% CI: 4.44 to 9.67) and stroke (hazard ratio: 4.03; 95% CI: 1.54 to 10.52).
Conclusions Infective endocarditis after TAVR most frequently occurs during the early period, is commonly caused by Enterococcus species, and results in considerable risks of mortality and stroke. (NCT01368250)
The SwissTAVI Registry is supported by a study grant from the Swiss Heart Foundation and the Swiss Working Group of Interventional Cardiology and Acute Coronary Syndromes, and is sponsored by funds from Medtronic, Edwards Lifesciences, Boston Scientific, Symetis, JenaValve, and Abbott. The study sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the paper. Dr. Stortecky has received research grants to the institution from Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific; has received speaker fees from Boston Scientific; and has received consulting fees from BTG and Teleflex. Dr. Heg is affiliated with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees; however, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations, in particular, pharmaceutical and medical device companies provide direct funding to some of these studies. Dr. Tueller has received speaker fees from Edwards Lifesciences and Boston Scientific; and has received reimbursement for travel expenses from Edwards Lifesciences, Boston Scientific, and Medtronic. Dr. Pilgrim has received research grants to the institution from Edwards Lifesciences, Biotronik, and Boston Scientific; and has received speaker fees from Boston Scientific and Biotronik. Dr. Muller has served as a consultant for Abbott; and has received speaker fees from Edwards Lifesciences. Dr. Noble has served as a consultant for Medtronic; has received institutional research grants from Abbott Vascular; and has served as a proctor for Medtronic. Dr. Jeger has served as a consultant for Abbott; and has received reimbursement for travel expenses from Boston Scientific, Medtronic, and Edwards Lifesciences. Dr. Toggweiler has served as a consultant and proctor for Boston Scientific and New Valve Technology; has served as a proctor for Abbott Vascular; has received an institutional research grant from Boston Scientific; and has equity in Hi-D Imaging AG. Dr. Ferrari has served as a proctor and consultant for Edwards Lifesciences. Dr. Taramasso has served as a consultant for Abbott, Boston Scientific, and 4Tech; and has received speaker fees from Edwards Lifesciences. Dr. Maisano has received grant and/or research support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, and Terumo; has received consulting fees/honoraria from Abbott, Medtronic, Edwards Lifesciences, SwissVortex, Perifect, Xeltis, Transseptal Solutions, CardioValve, and Magenta; has received royalty income/IP rights from Edwards Lifesciences (FMR surgical annuloplasty); and is a shareholder of CardioValve, Magenta, SwissVortex, Transseptal Solutions, Occlufit, 4Tech, and Perifect. Dr. Wenaweser has served as a proctor for and received proctor/lecture fees from Edwards Lifesciences and Medtronic. Dr. Nietlispach has served as a consultant for Edwards Lifesciences and Abbott. Dr. Huber has served as a proctor for Edwards Lifesciences and Boston Scientific/Symetis. Dr. Roffi has received institutional research grants from Abbott Vascular, Boston Scientific, Biotronik, Terumo, and Medtronic. Dr. Windecker has received research contracts to the institution from Abbott, Amgen, Bayer, Bristol-Myers Squibb, CSL Behring, Boston Scientific, Biotronik, Medtronic, Edwards Lifesciences, Polares, and Sinomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received December 30, 2019.
- Revision received April 16, 2020.
- Accepted April 17, 2020.
- 2020 American College of Cardiology Foundation
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