From Quebec Heart & Lung Institute, Quebec, Canada (I.J.A.-S., H.B.R., M.U., E.D., P.P., J.R.-C.); Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., J.L, A.S.R.); Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.M.-Z., B.I., A.V.); Hôpital Charles Nicolle, University of Rouen, France (H.E., E.D.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia, E.M.T.); Emory University School of Medicine, Division of Cardiology, Atlanta, GA (S.L., S.S.H.); St. Michael's Hospital Toronto, ON, Canada (A.C.); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (E.G.-I., R.A.-L.); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., J.J.G.-D.); Hospital Universitario Reina Sofía, Córdoba, Spain (M.P., J.C.C.); St. Paul's Hospital, Vancouver, BC, Canada (J.G.W., D.D.); Hospital of the University of Pennsylvania, Philadelphia (H.H.); Columbia University Medical Center/New York Presbyterian Hospital, NY (S. Kodali, M.B.L.); Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain (L.N.-F., E.G., J.C., I.V.); Ferrarotto Hospital, University of Catania, Italy (C.T., M.B.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J., R.M.); Centre Hospitalier de l'Université de Montréal, QC, Canada (J.-B.M.); Hospital Israelita Albert Einstein, Sao Paulo, Brazil (F.S.d.B.); Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil (M.C.F.); Hospital Sao Francisco-Santa Casa de Misericórdia, Porto Alegre, Porto Alegre, Brazil (V.C.L.); and Hospital Beneficência Portuguesa, Sao Paulo, Brazil (J.A.M.).
Circulation. 2015 May 5;131(18):1566-74. doi: 10.1161/CIRCULATIONAHA.114.014089. Epub 2015 Mar 9.
We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI).
This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1-14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55-9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37-7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality.
The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.
我们旨在确定经导管主动脉瓣置换术（TAVI）后感染性心内膜炎（IE）的发生率、预测因素、临床特征、治疗方法和结局。
这项多中心注册研究纳入了 53 名 TAVI 后发生 IE 的患者（平均年龄 79±8 岁，男性占 57%），这些患者在平均 1.1±1.2 年的随访中（发生率为 0.67%，TAVI 后 1 年内发生率为 0.50%）。从 TAVI 到 IE 的平均时间为 6 个月（四分位间距，1-14 个月）。气管插管（风险比，3.87；95%置信区间，1.55-9.64；P=0.004）和自膨式 CoreValve 系统（风险比，3.12；95%置信区间，1.37-7.14；P=0.007）与 IE 相关（包括 3067 名有个人数据的患者的多变量分析）。最常见的病原体为凝固酶阴性葡萄球菌（24%），其次为金黄色葡萄球菌（21%）和肠球菌（21%）。77%的患者有赘生物（经导管瓣膜叶 39%，支架框架 17%，二尖瓣 21%）。87%的患者至少发生 1 种 IE 并发症（心力衰竭 68%）。然而，仅有 11%的患者接受了瓣膜干预（瓣膜切除和瓣膜置换术各 4 例和 2 例）。住院期间的死亡率为 47.2%，1 年随访时增至 66%。IE 并发症如心力衰竭（P=0.037）和感染性休克（P=0.002）与住院期间死亡率增加相关。
TAVI 后 1 年 IE 的发生率为 0.50%，使用气管插管和自膨式瓣膜系统会增加风险。葡萄球菌和肠球菌是最常见的病原体。尽管大多数患者至少出现 1 种 IE 并发症，但仅有少数患者接受了瓣膜干预，近一半的患者在住院期间死亡。
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