Mortality Risk for Patients Receiving Antibiotics, Surgery for TAVI Infective Endocarditis

Mortality among patients who develop infective endocarditis (IE) after receiving transcatheter aortic valve implantation (TAVI) was associated with patient characteristics and pathogen, not treatment strategy. These findings were published in the Journal of the American College of Cardiology.

This study evaluated data collected for the observational, multicenter, international Infections Endocarditis after TAVI International Registry. Patients (N=584) who developed TAVI-IE at 59 centers in 11 countries between 2005 and 2020 were assessed for characteristics, treatment strategy, and outcomes.

Patients were aged median 80.7 (IQR, 75.4-84.7) years, 37.5% were women, BMI was 26.9 (IQR, 24.1-30.7), TAVI implantation occurred in an operating or hybrid room for 59.9%, 88.0% had a transfemoral approach, 52.6% received a balloon-expandable prosthesis, and 93.8% had beta-lactam antibiotic prophylaxis only. Most patients received antibiotic therapy alone (n=473) and a minority underwent cardiac surgery (n=111).

Patients who were treated with surgery had an increased risk for periannular complication (hazard ratio [HR], 2.74; 95% CI, 1.73-4.34; P <.001), TAVI platform involvement (HR, 2.16; 95% CI, 1.36-3.43; P =.001), and echocardiographic vegetation (HR, 2.02; 95% CI, 1.26-3.23; P =.003).

The surgical cohort also had increased risk for IE complications of other systemic embolization (HR, 2.67; 95% CI, 1.50-4.77; P <.001), persistent bacteremia (HR, 2.27; 95% CI, 1.48-3.49; P <.001), any complication (HR, 2.16; 95% CI, 1.27-3.68; P =.004), and heart failure (HR, 2.14; 95% CI, 1.41-3.25; P <.001).

Among the surgical and antibiotic recipients, in-hospital mortality occurred in 29.1% and 32.6% (P =.420); 1-year mortality among 47.1% and 48.2% (P =.448); 2-year mortality among 56.3% and 55.0% (P =.535); and 2-year recurrence rates were 8.9% and 13.0% (P =.312), respectively.

Significant predictors of 1-year mortality were septic shock, acute renal failure, and persistent bacteremia.

Similar trends were observed among the subset of patients who did and did not have TAVI involvement.

This study was limited by the observational nature and could not account for differences in treatment decisions.

This study found that mortality following TAVI-IE was associated with patient characteristics and infectious pathogen rather than treatment received. “Moreover, because both treatment options are associated with an equal worse outcome, prevention and early diagnosis of infective endocarditis are of utmost importance,” the study authors noted.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Mangner N, del Val D, Abdel-Wahab M, et al. Surgical treatment of patients with infective endocarditis after transcatheter aortic valve implantation. J Am Coll Cardiol. Published online March 1, 2022. doi:10.1016/j.jacc.2021.11.056