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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, * 
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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Submitted on : Wednesday, March 2, 2022 - 10:35:36 AM
Last modification on : Wednesday, September 14, 2022 - 10:20:04 AM

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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, Elsevier, 2022, 79 (8), pp.772-785. ⟨10.1016/j.jacc.2021.11.056⟩. ⟨hal-03593617⟩

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