Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation

Vassili Panagides (1) , David del Val (1) , Mohamed Abdel-Wahab (2) , Norman Mangner (2, 3) , Eric Durand (4) , Nikolaj Ihlemann (5) , Marina Urena (6) , Costanza Pellegrini (7) , Francesco Giannini (8) , Piotr Scislo (9) , Zenon Huczek (9) , Martin Landt , Vincent Auffret (10, 11) , Jan Malte Sinning , Asim Cheema , Luis Nombela-Franco , Chekrallah Chamandi (12) , Francisco Campelo-Parada (13) , Erika Munoz-Garcia , Howard Herrmann , Luca Testa , Won-Keun Kim , Juan Carlos Castillo , Alberto Alperi , Didier Tchetche , 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 , 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 , David Holzhey (2) , Josep Rodés-Cabau (1)

1 ULaval - Université Laval [Québec]
2 Universität Leipzig [Leipzig]
3 TU Dresden - Technische Universität Dresden = Dresden University of Technology
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 Rigshospitalet [Copenhagen]
6 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
7 DHM - Deutsches Herzzentrum München
8 Ospedale San Raffaele
9 Medical University of Warsaw - Poland
10 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
11 LTSI - Laboratoire Traitement du Signal et de l'Image
12 HEGP - Hôpital Européen Georges Pompidou [APHP]
13 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse

Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.

Domains: Life Sciences [q-bio]; Bioengineering

Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, et al.. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation. American Journal of Cardiology, 2022, 172, pp.90-97. ⟨10.1016/j.amjcard.2022.02.034⟩. ⟨hal-03689879⟩