Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

Norman Mangner (1) , David Del Val (2) , Mohamed Abdel-Wahab (3) , Lisa Crusius (1) , Eric Durand (4) , Nikolaj Ihlemann , Marina Urena (5) , Costanza Pellegrini , Francesco Giannini , Tomasz Gasior , Wojtek Wojakowski , Martin Landt , Vincent Auffret (6, 7) , Jan Malte Sinning , Asim Cheema , Luis Nombela-Franco , Chekrallah Chamandi (8) , Francisco Campelo-Parada (9) , Erika Munoz-Garcia , Howard Herrmann , Luca Testa , Won-Keun Kim , Juan Carlos Castillo , Alberto Alperi , Didier Tchetche (10) , 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 , 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 (4) , Lars Søndergaard , Dominique Himbert , Oliver Husser , Azeem Latib , Hervé Le Breton (6, 7) , Clement Servoz , Isaac Pascual , Saif Siddiqui , Paolo Olivares , Rosana Hernandez-Antolin , John Webb , Sandro Sponga , Raj Makkar , Annapoorna Kini , Marouane Boukhris , Philippe Gervais (2) , Mélanie Côté (2) , David Holzhey (3) , Axel Linke (1) , Josep Rodés-Cabau (2)

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

Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain.Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB).Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry.Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock.Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications.

Mots clés: TAVI; antibiotics; cardiac surgery; infective endocarditis; outcome

Domaines: Cardiologie et système cardiovasculaire

Norman Mangner, David Del Val, Mohamed Abdel-Wahab, Lisa Crusius, Eric Durand, et al.. Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. Journal of the American College of Cardiology, 2022, 79 (8), pp.772-785. ⟨10.1016/j.jacc.2021.11.056⟩. ⟨hal-03593617⟩