Patients with infective endocarditis (IE) following transcatheter aortic valve implantation (TAVI) tend to be older with more comorbidities, with Enterococcus spp. and Streptococcus spp. frequently present, according to study findings published in Clinical Infectious Diseases.
Investigators in Denmark sought to describe patient characteristics, microbiology, and prognosis of IE after TAVI.
They conducted a cohort study using Danish nationwide registries and the Danish Microbiology Database to identify 273 patients with IE after TAVI, 1022 patients with IE after non-TAVI prosthetic valve placement, and 5376 patients with native valve IE from January 2010 to December 2021. Patients were followed from admission for IE until 5 years of follow-up, date of death, emigration, or end of study.
Compared with patients with IE after non-TAVI prosthetic valve placement (median age, 76 years; frail, 56.4%) and patients with native valve IE (median age, 71 years; frail, 45.7%), patients with IE after TAVI were older and more had intermediate or high frailty (median age, 82 years; frail, 61.2%). Frailty was defined using The Hospital Frailty Risk Score that included all hospital contacts up to 10 years prior to IE (0-4 points, low; 5-15 points, intermediate; >15 points, high).
Prescriptions filled within 180 days before IE were used to identify comorbidities (hypertension: at least 2 filled prescriptions for blood pressure lowering drugs; diabetes: at least 1 filled prescription of a glucose lowering drug). Cardiovascular comorbidity was higher for IE after TAVI compared with the other groups, and cancer, diabetes, and chronic obstructive pulmonary disease were comparable between groups.
In sensitivity analysis, patients with IE after TAVI were matched 1:2:3 with patients with IE after non-TAVI prosthetic valve placement and patients with native valve IE (matched for sex, age, and calendar year of endocarditis).
Compared with patients with native valve IE (11.4%), Enterococcus spp. was common in patients with IE after TAVI (27.1%) and IE after non-TAVI prosthetic valve placement (21.2%), as was Streptococcus spp. for patients with IE after TAVI (30.8%) compared with patients with IE after non-TAVI prosthetic valve placement (22.0%) and patients with native valve IE (24.1%). Compared with patients with IE after non-TAVI prosthetic valve placement (15.2%) and patients with native valve IE (13.5%), blood culture negative IE was infrequent in patients with IE after TAVI (5.5%).
Compared with patients with IE after non-TAVI prosthetic valve placement (57.2%) and patients with native valve IE (53.6%), 5-year mortality was highest for patients with IE after TAVI (75.2%). No between-group differences were found for the unadjusted 90-day mortality rate. No significant difference was found in mortality rates between groups at 1 to 90 days and 91 to 365 days using Cox models adjusted for bacterial etiology and patient characteristics. Cardiac procedures were performed on 3.7% of patients with IE after TAVI, 17.8% of patients with non-TAVI prosthetic valve placement, and on 19.5% of patients with native valve IE. In general, and regardless of in-hospital cardiac procedures, patients with Staphylococcus aureus had the highest mortality rate.
Study limitations include the inability to determine the anatomical location of endocarditis and missing data for TAVI group procedural characteristics, as well as data for dental status, long-term catheter use, and type of valve prosthesis.
“Patients with IE after TAVI are older and more comorbid, Enterococcus spp. and Streptococcus spp. are often present, and rarely blood culture negative compared with other groups of IE,” the investigators wrote. “While long-term unadjusted mortality rates were higher for IE after TAVI, the adjusted mortality rates were comparable.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Strange JE, Østergaard L, Køber L, et al. Patient characteristics, microbiology, and mortality of infective endocarditis after transcatheter aortic valve implantation. Clin Infect Dis. Published online July 20, 2023. doi:10.1093/cid/ciad431