In the Journals

Long-term infective endocarditis odds similar between TAVR, surgical AVR

The incidence of long-term infective endocarditis following transcatheter aortic valve replacement showed little difference compared with surgical AVR, according to findings published in the Journal of the American College of Cardiology.

Jawad H. Butt, MD, and colleagues examined long-term incidence of infective endocarditis in patients undergoing TAVR compared with patients undergoing isolated surgical AVR.

“Although the risk of [infective endocarditis] after surgical valve replacement is well-characterized, data on the risk of this complication in the setting of TAVR are sparse and limited by either lack of long-term follow-up or a small number of patients,” Butt, a research fellow in the department of cardiology at Rigshospitalet at Copenhagen University Hospital in Denmark, and colleagues wrote. “Due to certain characteristics of patients eligible for TAVR, patients treated with TAVR may potentially carry a higher risk of [infective endocarditis] compared with those undergoing [surgical] AVR.”

Time to infective endocarditis

The researchers analyzed data from Danish nationwide registries of patients undergoing TAVR and surgical AVR between 2008 to 2016. All patients had no history of infective endocarditis and were alive at discharge.

Butt and colleagues identified 2,632 patients who had TAVR and 3,777 who had surgical AVR. During a mean follow-up of 3.6 years, 4.4% of TAVR patients and 4.9% of surgical AVR patients were hospitalized with infective endocarditis.

Median time from procedure to infective endocarditis in the TAVR group was 352 days (interquartile range, 133-778) and 625 days in the surgical AVR group (interquartile range, 209 to 1,385 days), the researchers wrote.

The incidence of long-term infective endocarditis following transcatheter aortic valve replacement showed little difference compared with surgical AVR, according to findings published in the Journal of the American College of Cardiology.
Source: Shutterstock

The crude incidence rate was slightly higher in the TAVR group (1.6 events per 100 person-years; 95% CI, 1.4-1.9) compared with the surgical AVR group (1.2 events per 100 person-years; 95% CI, 1-1.4), Butt and colleagues wrote.

Cumulative 1-year risk for infective endocarditis was greater in TAVR patients (2.3%; 95% CI, 1.8-2.9) compared with surgical AVR (1.8%; 95% CI, 1.4-2.3), the researchers wrote. The cumulative 5-year risk for infective endocarditis was also higher in TAVR patients (5.8%; 95% CI, 4.7-7) compared with surgical AVR (5.1%, 95% CI, 4.4-6).

However, in a multivariable Cox proportional hazard analysis, there was no significant statistical difference in infective endocarditis risk after TAVR compared with surgical AVR (HR = 1.12; 95% CI, 0.84-1.49).

The researchers wrote additional studies are needed to identify predictors of infective endocarditis in patients who have undergone surgical AVR and enhance strategies for effective prophylaxis.

Dramatic consequences

In a related editorial, Bernard Iung, MD, and Claire Bouleti, MD, PhD, cardiologists at Bichat University Hospital and DHU Fire in Paris, wrote: “The present study underlines the high intrahospital mortality in TAVR patients, as previously reported. The consequences of TAVR [infective endocarditis] are indeed dramatic because TAVR is mainly performed in elderly, frail patients with comorbidities, who are frequently not considered for high-risk surgery in case of [infective endocarditis]. Prophylactic measures are therefore critical in this particular population.” – by Earl Holland Jr.

Disclosures: Bouleti and Butt report no relevant financial disclosures. Iung reports receiving consultant fees from Edwards Lifesciences and speaker fees from Boehringer Ingelheim and Novartis. Please see the study for all other authors’ relevant financial disclosures.

The incidence of long-term infective endocarditis following transcatheter aortic valve replacement showed little difference compared with surgical AVR, according to findings published in the Journal of the American College of Cardiology.

Jawad H. Butt, MD, and colleagues examined long-term incidence of infective endocarditis in patients undergoing TAVR compared with patients undergoing isolated surgical AVR.

“Although the risk of [infective endocarditis] after surgical valve replacement is well-characterized, data on the risk of this complication in the setting of TAVR are sparse and limited by either lack of long-term follow-up or a small number of patients,” Butt, a research fellow in the department of cardiology at Rigshospitalet at Copenhagen University Hospital in Denmark, and colleagues wrote. “Due to certain characteristics of patients eligible for TAVR, patients treated with TAVR may potentially carry a higher risk of [infective endocarditis] compared with those undergoing [surgical] AVR.”

Time to infective endocarditis

The researchers analyzed data from Danish nationwide registries of patients undergoing TAVR and surgical AVR between 2008 to 2016. All patients had no history of infective endocarditis and were alive at discharge.

Butt and colleagues identified 2,632 patients who had TAVR and 3,777 who had surgical AVR. During a mean follow-up of 3.6 years, 4.4% of TAVR patients and 4.9% of surgical AVR patients were hospitalized with infective endocarditis.

Median time from procedure to infective endocarditis in the TAVR group was 352 days (interquartile range, 133-778) and 625 days in the surgical AVR group (interquartile range, 209 to 1,385 days), the researchers wrote.

The incidence of long-term infective endocarditis following transcatheter aortic valve replacement showed little difference compared with surgical AVR, according to findings published in the Journal of the American College of Cardiology.
Source: Shutterstock

The crude incidence rate was slightly higher in the TAVR group (1.6 events per 100 person-years; 95% CI, 1.4-1.9) compared with the surgical AVR group (1.2 events per 100 person-years; 95% CI, 1-1.4), Butt and colleagues wrote.

Cumulative 1-year risk for infective endocarditis was greater in TAVR patients (2.3%; 95% CI, 1.8-2.9) compared with surgical AVR (1.8%; 95% CI, 1.4-2.3), the researchers wrote. The cumulative 5-year risk for infective endocarditis was also higher in TAVR patients (5.8%; 95% CI, 4.7-7) compared with surgical AVR (5.1%, 95% CI, 4.4-6).

However, in a multivariable Cox proportional hazard analysis, there was no significant statistical difference in infective endocarditis risk after TAVR compared with surgical AVR (HR = 1.12; 95% CI, 0.84-1.49).

The researchers wrote additional studies are needed to identify predictors of infective endocarditis in patients who have undergone surgical AVR and enhance strategies for effective prophylaxis.

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Dramatic consequences

In a related editorial, Bernard Iung, MD, and Claire Bouleti, MD, PhD, cardiologists at Bichat University Hospital and DHU Fire in Paris, wrote: “The present study underlines the high intrahospital mortality in TAVR patients, as previously reported. The consequences of TAVR [infective endocarditis] are indeed dramatic because TAVR is mainly performed in elderly, frail patients with comorbidities, who are frequently not considered for high-risk surgery in case of [infective endocarditis]. Prophylactic measures are therefore critical in this particular population.” – by Earl Holland Jr.

Disclosures: Bouleti and Butt report no relevant financial disclosures. Iung reports receiving consultant fees from Edwards Lifesciences and speaker fees from Boehringer Ingelheim and Novartis. Please see the study for all other authors’ relevant financial disclosures.