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)

1 ULaval - Université Laval [Québec]
2 Universität Leipzig [Leipzig]
3 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
4 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
5 LTSI - Laboratoire Traitement du Signal et de l'Image
6 CHU Pontchaillou [Rennes]
7 HEGP - Hôpital Européen Georges Pompidou [APHP]
8 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
9 Clinique Pasteur [Toulouse]
10 TU Dresden - Technische Universität Dresden = Dresden University of Technology
11 Leipzig University

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.

Keywords: Infective endocarditis; TAVI; TAVR; heart surgery

Domains: Life Sciences [q-bio]; Human health and pathology; Infectious diseases

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, 2021, ⟨10.1093/cid/ciab1004⟩. ⟨hal-03520845⟩