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Long-Term Risk of Infective Endocarditis After TAVR
Study Questions:
What is the long-term incidence of infective endocarditis (IE) among patients undergoing transcatheter aortic valve replacement (TAVR), and how does it compare to the risk of IE after isolated surgical aortic valve replacement (SAVR)?
Methods:
Using administrative Danish nationwide registries in an observational cohort study, all patients were identified who underwent TAVR or isolated SAVR from 2008 through 2016 with no prior history of IE and who were alive at discharge. The Danish National Patient Registry was used to find subsequent diagnoses of IE.
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 (interquartile range [IQR], 133-778 days) in the TAVR group and 625 days (IQR, 209-1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI], 1.4-1.9) and 1.2 (95% CI, 1.0-1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI, 1.8-2.9%) and 1.8% (95% CI, 1.4-2.3%) in TAVR and SAVR groups, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI, 4.7-7.0%) and 5.1% (95% CI, 4.4-6.0%), respectively. Male sex and chronic kidney disease were associated with a higher risk of IE among patients who underwent TAVR, whereas male sex and diabetes were associated with a higher risk of IE after SAVR. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significantly different risk of IE compared with SAVR (hazard ratio, 1.12; 95% CI, 0.84-1.49). In-hospital mortality for IE was 20.9% among patients after TAVR and 14.0% among patients after SAVR.
Conclusions:
The 5-year incidence of IE following TAVR was 5.8%, and not significantly different than the incidence of IE following SAVR.
Perspective:
Patients are at increased risk of IE following SAVR. Data from this national registry suggest that the risk of IE is not significantly different after TAVR compared to SAVR. Higher in-hospital mortality associated with IE after TAVR compared to SAVR could reflect greater age and co-morbidities or a more conservative treatment strategy in the TAVR group.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Diabetes Mellitus, Endocarditis, Endocarditis, Bacterial, Heart Valve Diseases, Heart Valve Prosthesis, Hospital Mortality, Patient Discharge, Renal Insufficiency, Chronic, Risk, Transcatheter Aortic Valve Replacement
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