In the Journals

Risk for endocarditis similar in TAVR, surgical AVR

Wael A. Jaber

The predictors, incidence or risk for prosthetic valve endocarditis were similar in patients with severe aortic stenosis regardless of whether they underwent transcatheter aortic valve replacement or surgical AVR, according to a cohort study of patients from PARTNER I and PARTNER II trials published in Circulation.

“The reassuring thing is that these valves with TAVR have a very low rate of infections, extremely low rate, and it doesn’t seem to be procedure-related because most of the infections are happening 30 days plus after the procedure,” Wael A. Jaber, MD, medical director of the Cardiovascular Imaging Core Laboratory and of nuclear cardiology in C5Research, head of the center for advanced ischemic heart disease and cardiologist in the section of cardiovascular imaging at Cleveland Clinic, told Cardiology Today. “We can say very confidently that TAVR does not expose you to a higher risk of valve infection, and the valve infection, whether it happens after TAVR or SAVR, is equally bad.”

PARTNER trial data

Matthew R. Summers, MD, interventional cardiology fellow at Cleveland Clinic at the time of the study and now an interventional cardiologist at Sentara Healthcare in Norfolk, Virginia, and colleagues analyzed data from 8,530 patients from the PARTNER I and PARTNER II trials with severe aortic stenosis who underwent either TAVR (n = 7,273) or surgical AVR (n = 1,257). Patients were followed up for the development of prosthetic valve endocarditis for a mean of 2.69 years.

During follow-up, 107 patients developed prosthetic valve endocarditis for an incidence rate of 5.06 per 1,000 person-years (95% CI, 4.19-6.12).

The incidence of prosthetic valve endocarditis in patients who underwent TAVR (5.21 per 1,000 person-years; 95% CI, 4.26-6.38) was not significantly different compared with the incidence in patients who underwent surgical AVR (4.1 per 1,000 person-years; 95% CI, 2.33-7.22; incidence rate ratio (IRR) = 1.27; 95% CI, 0.7-2.32; P = .44). Both groups had similar temporal risk for prosthetic valve endocarditis after adjusting for a competing risk for death (HR = 1.15; 95% CI, 0.58-2.28).

Prosthetic valve endocarditis was associated with baseline pulmonary disease (IRR = 1.7; 95% CI, 1.16-2.48; P = .006), cirrhosis (IRR = 2.86; 95% CI, 1.33-6.16; P = .007) and renal insufficiency (IRR = 1.71; 95% CI, 1.03-2.83; P = .04).

The development of prosthetic valve endocarditis was similar in the TAVR and surgical AVR groups at less than 30 days (4.2% vs. 8.3%, respectively), between 31 days and 1 year (52.6% vs. 66.7%, respectively) and greater than 1 year (43.2% vs. 25%; P = .28).

Staphylococcus was seen more often in patients after surgical AVR vs. TAVR (58.3% vs. 28.4%; P = .04). Prosthetic valve endocarditis was linked with all-cause mortality after a diagnosis of endocarditis (HR = 4.42; 95% CI, 3.42-5.72).

Discussing risks with patients

“Whenever we need to talk to these patients about risks of any of these procedures, we usually go through a laundry list of things that could happen or things that could happen down the road or potential complications,” Jaber said in an interview. “Now we have very clear evidence of what are these risks. ... Now we can sit down with these patients and say there’s no really superiority of either method as far as the risk of infection, but these are the risks of infections down the road.” – by Darlene Dobkowski

For more information:

Wael A. Jaber, MD, can be reached at Cleveland Clinic Foundation, 9500 Euclid Ave., J1-5, Cleveland, OH 44195; email: jaberw@ccf.org.

Disclosures: The PARTNER trials were funded and sponsored by Edwards Lifesciences. Summers reports no relevant financial disclosures. Jaber reports he has Core Laboratory contracts with Edwards Lifesciences. Please see the study for all other authors’ relevant financial disclosures.

Wael A. Jaber

The predictors, incidence or risk for prosthetic valve endocarditis were similar in patients with severe aortic stenosis regardless of whether they underwent transcatheter aortic valve replacement or surgical AVR, according to a cohort study of patients from PARTNER I and PARTNER II trials published in Circulation.

“The reassuring thing is that these valves with TAVR have a very low rate of infections, extremely low rate, and it doesn’t seem to be procedure-related because most of the infections are happening 30 days plus after the procedure,” Wael A. Jaber, MD, medical director of the Cardiovascular Imaging Core Laboratory and of nuclear cardiology in C5Research, head of the center for advanced ischemic heart disease and cardiologist in the section of cardiovascular imaging at Cleveland Clinic, told Cardiology Today. “We can say very confidently that TAVR does not expose you to a higher risk of valve infection, and the valve infection, whether it happens after TAVR or SAVR, is equally bad.”

PARTNER trial data

Matthew R. Summers, MD, interventional cardiology fellow at Cleveland Clinic at the time of the study and now an interventional cardiologist at Sentara Healthcare in Norfolk, Virginia, and colleagues analyzed data from 8,530 patients from the PARTNER I and PARTNER II trials with severe aortic stenosis who underwent either TAVR (n = 7,273) or surgical AVR (n = 1,257). Patients were followed up for the development of prosthetic valve endocarditis for a mean of 2.69 years.

During follow-up, 107 patients developed prosthetic valve endocarditis for an incidence rate of 5.06 per 1,000 person-years (95% CI, 4.19-6.12).

The incidence of prosthetic valve endocarditis in patients who underwent TAVR (5.21 per 1,000 person-years; 95% CI, 4.26-6.38) was not significantly different compared with the incidence in patients who underwent surgical AVR (4.1 per 1,000 person-years; 95% CI, 2.33-7.22; incidence rate ratio (IRR) = 1.27; 95% CI, 0.7-2.32; P = .44). Both groups had similar temporal risk for prosthetic valve endocarditis after adjusting for a competing risk for death (HR = 1.15; 95% CI, 0.58-2.28).

Prosthetic valve endocarditis was associated with baseline pulmonary disease (IRR = 1.7; 95% CI, 1.16-2.48; P = .006), cirrhosis (IRR = 2.86; 95% CI, 1.33-6.16; P = .007) and renal insufficiency (IRR = 1.71; 95% CI, 1.03-2.83; P = .04).

The development of prosthetic valve endocarditis was similar in the TAVR and surgical AVR groups at less than 30 days (4.2% vs. 8.3%, respectively), between 31 days and 1 year (52.6% vs. 66.7%, respectively) and greater than 1 year (43.2% vs. 25%; P = .28).

PAGE BREAK

Staphylococcus was seen more often in patients after surgical AVR vs. TAVR (58.3% vs. 28.4%; P = .04). Prosthetic valve endocarditis was linked with all-cause mortality after a diagnosis of endocarditis (HR = 4.42; 95% CI, 3.42-5.72).

Discussing risks with patients

“Whenever we need to talk to these patients about risks of any of these procedures, we usually go through a laundry list of things that could happen or things that could happen down the road or potential complications,” Jaber said in an interview. “Now we have very clear evidence of what are these risks. ... Now we can sit down with these patients and say there’s no really superiority of either method as far as the risk of infection, but these are the risks of infections down the road.” – by Darlene Dobkowski

For more information:

Wael A. Jaber, MD, can be reached at Cleveland Clinic Foundation, 9500 Euclid Ave., J1-5, Cleveland, OH 44195; email: jaberw@ccf.org.

Disclosures: The PARTNER trials were funded and sponsored by Edwards Lifesciences. Summers reports no relevant financial disclosures. Jaber reports he has Core Laboratory contracts with Edwards Lifesciences. Please see the study for all other authors’ relevant financial disclosures.