Department of Cardiology, Leeds General Infirmary, Leeds, UK.
J Cardiovasc Med (Hagerstown). 2020 Jul;21(7):510-516. doi: 10.2459/JCM.0000000000000961.
The aims were to report the incidence and outcomes of transcatheter aortic valve implantation-infective endocarditis (TAVI-IE) from a high-volume TAVI centre in the United Kingdom, including how incidence varies relative to time from the procedure, and to assess the performance of modified Duke criteria in the diagnosis of TAVI-IE.
The retrospective, cohort study included all patients who underwent TAVI at Leeds Teaching Hospitals Trust during a 10-year period. Outcome measures were the incidence of TAVI-IE, the accuracy of the modified Duke criteria and the mortality rate.
A total of 1337 patients were followed up for a median of 2.3 years. Thirteen patients (0.97%) were diagnosed with TAVI-IE, mean age of 81.3 years (SD 5.1 years). Four patients (30.8%) fulfilled modified Duke criteria for definite infective endocarditis. The remaining nine patients (69.2%) fulfilled the modified Duke criteria for possible infective endocarditis. In the majority (7/13; 53.8%) the causative organism was streptococcal. Cumulative incidence of TAVI-IE has risen in line with the number of patients living with TAVI prostheses, and cumulative number of TAVI-years. However, in relation to the number of 100 TAVI-years, the infection rate has remained low and static over the last 6 years. The in-hospital mortality rate was 38.5%, all attributable to TAVI-IE.
The incidence of TAVI-IE was 0.97%, with an associated all-cause mortality of 53.8%. The incidence relative to the number of TAVI-years has remained low and static in recent years. The modified Duke criteria have relatively low sensitivity in the diagnosis of TAVI-IE, meaning that a high index of suspicion is required.
本研究旨在报告英国一家大型经导管主动脉瓣植入术（TAVI）中心的 TAVI 感染性心内膜炎（TAVI-IE）的发生率和结局，包括该发病率与术后时间的关系，并评估改良的 Duke 标准在 TAVI-IE 诊断中的表现。
这项回顾性队列研究纳入了利兹教学医院信托基金在 10 年期间接受 TAVI 的所有患者。主要结局指标为 TAVI-IE 的发生率、改良 Duke 标准的准确性和死亡率。
共对 1337 例患者进行了中位 2.3 年的随访。13 例（0.97%）患者诊断为 TAVI-IE，平均年龄为 81.3 岁（标准差为 5.1 岁）。4 例（30.8%）患者符合改良 Duke 标准诊断为明确感染性心内膜炎。其余 9 例（69.2%）患者符合改良 Duke 标准诊断为可能感染性心内膜炎。在大多数患者（7/13；53.8%）中，病原体为链球菌。TAVI-IE 的累积发生率与 TAVI 假体和 TAVI 年数的患者数量成正比。然而，与 100 个 TAVI 年相比，过去 6 年来，感染率保持在较低且稳定的水平。住院死亡率为 38.5%，均归因于 TAVI-IE。
TAVI-IE 的发生率为 0.97%，总死亡率为 53.8%。近年来，TAVI 年数与发病率的比值保持在较低且稳定的水平。改良的 Duke 标准在 TAVI-IE 的诊断中敏感性相对较低，这意味着需要高度怀疑。
