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Journal Articles Journal of the American College of Cardiology Year : 2022

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

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Mohamed Abdel-Wahab
Nikolaj Ihlemann
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Costanza Pellegrini
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Francesco Giannini
Tomasz Gasior
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Wojtek Wojakowski
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Martin Landt
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Jan Malte Sinning
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Asim Cheema
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Luis Nombela-Franco
Francisco Campelo-Parada
Erika Munoz-Garcia
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Howard Herrmann
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Luca Testa
Won-Keun Kim
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Juan Carlos Castillo
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Alberto Alperi
Antonio Bartorelli
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Samir Kapadia
Stefan Stortecky
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Ignacio Amat-Santos
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Harindra Wijeysundera
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John Lisko
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Enrique Gutiérrez-Ibanes
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Vicenç Serra
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Luisa Salido
Abdullah Alkhodair
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Ugolino Livi
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Tarun Chakravarty
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Stamatios Lerakis
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Victoria Vilalta
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Ander Regueiro
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Rafael Romaguera
Utz Kappert
Marco Barbanti
Jean-Bernard Masson
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Frédéric Maes
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Claudia Fiorina
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Antonio Miceli
Susheel Kodali
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Henrique Ribeiro
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Jose Armando Mangione
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Fabio Sandoli de Brito
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Guglielmo Mario Actis Dato
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Francesco Rosato
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Maria-Cristina Ferreira
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Valter Correia de Lima
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Alexandre Abizaid
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Marcos Antonio Marino
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Vinicius Esteves
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Julio Andrea
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Roger Godinho
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Fernando Alfonso
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Lars Søndergaard
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Dominique Himbert
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Oliver Husser
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Azeem Latib
Clement Servoz
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Isaac Pascual
Saif Siddiqui
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Paolo Olivares
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Rosana Hernandez-Antolin
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John Webb
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Sandro Sponga
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Raj Makkar
Annapoorna Kini
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Marouane Boukhris
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David Holzhey
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Abstract

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.
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Dates and versions

hal-03593617 , version 1 (02-03-2022)

Identifiers

Cite

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⟩
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