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. 2023 Dec 15;77(12):1617-1625.
doi: 10.1093/cid/ciad431.

Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation

Jarl Emanuel Strange  1   2 , Lauge Østergaard  1 , Lars Køber  1 , Henning Bundgaard  1 , Kasper Iversen  2 , Marianne Voldstedlund  3 , Gunnar Hilmar Gislason  2   4   5 , Jonas Bjerring Olesen  2 , Emil Loldrup Fosbøl  1
Affiliations

Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation

Jarl Emanuel Strange et al. Clin Infect Dis. .

Abstract

Background: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI.

Methods: Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared.

Results: We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age: 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates.

Conclusions: Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.

Keywords: epidemiology; infective endocarditis; microbiology; outcomes; transcatheter aortic valve implantation.

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Conflict of interest statement

Potential conflicts of interest. L. K.: Lecture fees from AstraZeneca, Bayer, Boehringer, Novartis, and Novo. H. B.: Lecture fees from Amgen, MSD, Bristol-Myers Squibb, and Sanofi. M. V.: Lecture fees from MyLab Oy. J. B. O.: Speaker’s honoraria or consultancy fees from Bayer, Bristol-Myers Squibb, and Pfizer. E. L. F.: Independent research grant from Novo Nordisk Foundation. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Microbiological etiology of 273 patients with IE after TAVI and 5376 with native valve IE. Percentages above the bars sum to 100% within groups. Numbers inside the bars sum to the total amount of cases within groups. Abbreviations: CoNS, coagulase-negative staphylococci; IE, infective endocarditis; PV, prosthetic valve; TAVI, transcatheter aortic valve implantation.
Figure 2.
Figure 2.
Microbiological etiology of 119 cases of early (≤12 m) IE after TAVI versus 153 cases of late (>12 m) IE after TAVI. Abbreviations: CoNS, coagulase-negative staphylococci; IE, infective endocarditis; TAVI, transcatheter aortic valve implantation.
Figure 3.
Figure 3.
Short-term mortality. Ninety-day unadjusted mortality following IE after TAVI and native valve IE based on a reverse Kaplan-Meier curve. The shaded areas represent the 95% confidence interval for the IE after TAVI, IE after non-TAVI PV, and native valve IE groups, respectively. Abbreviations: IE, infective endocarditis; PV, prosthetic valve; TAVI, transcatheter aortic valve implantation.
Figure 4.
Figure 4.
Long-term mortality. Five-year unadjusted mortality following IE after TAVI and native valve IE based on a reverse Kaplan-Meier curve. The shaded areas represent the 95% confidence interval for the IE after TAVI, IE after non-TAVI PV, and native valve IE groups, respectively. Abbreviations: IE, infective endocarditis; PV, prosthetic valve; TAVI, transcatheter aortic valve implantation.
Figure 5.
Figure 5.
Microbiological etiology of 273 patients with IE after TAVI and 819 matched patients with native valve IE. Matching criteria were age, sex, and calendar year of IE. Percentages above the bars sum to 100% within groups. Numbers inside the bars sum to the total amount of cases within groups. Abbreviations: CoNS, coagulase-negative staphylococci; IE, infective endocarditis; PV, prosthetic valve; TAVI, transcatheter aortic valve implantation.
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