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Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement

Vassili Panagides 1 David del Val 1 Mohamed Abdel-Wahab 2 Norman Mangner 2 Eric Durand 3 Nikolaj Ihlemann Marina Urena 4 Costanza Pellegrini Francesco Giannini Tomasz Gasior Wojtek Wojakowski Martin Landt Vincent Auffret 5, 6 Jan Malte Sinning Asim Cheema Luis Nombela-Franco Chekrallah Chamandi 7 Francisco Campelo-Parada 8 Erika Munoz-Garcia Howard Herrmann Luca Testa Kim Won-Keun Juan Carlos Castillo Alberto Alperi Didier Tchetche 9 Antonio Bartorelli Samir Kapadia Stefan Stortecky Ignacio Amat-Santos Harindra Wijeysundera John Lisko Enrique Gutiérrez-Ibanes Vicenç Serra Luisa Salido Abdullah Alkhodair Ugolino Livi Tarun Chakravarty Stamatios Lerakis Victoria Vilalta Ander Regueiro Rafael Romaguera Utz Kappert Marco Barbanti Jean-Bernard Masson Frédéric Maes Claudia Fiorina Antonio Miceli Susheel Kodali Henrique Ribeiro Jose Armando Mangione Fabio Sandoli de Brito Jr Guglielmo Mario Actis Dato Francesco Rosato Maria-Cristina Ferreira Valter Correia de Lima Alexandre Siciliano Colafranceschi Alexandre Abizaid Marcos Antonio Marino Vinicius Esteves Julio Andrea Roger Godinho Fernando Alfonso Helene Eltchaninoff Lars Søndergaard Dominique Himbert Oliver Husser Azeem Latib Hervé Le Breton Clement Servoz Isaac Pascual Saif Siddiqui Paolo Olivares Rosana Hernandez-Antolin John Webb Sandro Sponga Raj Makkar Annapoorna Kini Marouane Boukhris Philippe Gervais Axel Linke Lisa Crusius 10, 11 David Holzhey 11 Josep Rodés-Cabau 1, * 
Abstract : Background: Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.Methods: This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings.Results: A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all).Conclusion: PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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Submitted on : Wednesday, January 26, 2022 - 10:41:56 AM
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Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, et al.. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clinical Infectious Diseases, Oxford University Press (OUP), 2021, ⟨10.1093/cid/ciab1004⟩. ⟨hal-03520845⟩

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