Brouwer J, van den Brink F S, Nijenhuis V J, Vossenberg T N, Delewi R, van Mourik M S, den Heijer P, Tanis W, Kievit P C, Holvoet W, Hermanides R S, Ten Berg J M
Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
Neth Heart J. 2020 Oct;28(10):520-525. doi: 10.1007/s12471-020-01420-2.
Transcatheter aortic valve replacement (TAVR) is increasingly being used as an alternative to conventional surgical valve replacement. Prosthetic valve endocarditis (PVE) is a rare but feared complication after TAVR, with reported first-year incidences varying from 0.57 to 3.1%. This study was performed to gain insight into the incidence and outcome of PVE after TAVR in the Netherlands.
A multicentre retrospective registry study was performed. All patients who underwent TAVR in the period 2010-2017 were screened for the diagnosis of infective endocarditis in the insurance database and checked for the presence of PVE before analysis of general characteristics, PVE parameters and outcome.
A total of 3968 patients who underwent TAVR were screened for PVE. During a median follow-up of 33.5 months (interquartile range (IQR) 22.8-45.8), 16 patients suffered from PVE (0.4%), with a median time to onset of 177 days (IQR 67.8-721.3). First-year incidence was 0.24%, and the overall incidence rate was 0.14 events per 1000 person-years. Overall mortality during follow-up in our study was 31%, of which 25% occurred in hospital. All patients were treated conservatively with intravenous antibiotics alone, and none underwent a re-intervention. Other complications of PVE occurred in 5 patients (31%) and included aortic abscess (2), decompensated heart failure (2) and cerebral embolisation (1).
PVE in patients receiving TAVR is a relatively rare complication and has a high mortality rate.
经导管主动脉瓣置换术（TAVR）越来越多地被用作传统外科瓣膜置换术的替代方法。人工瓣膜心内膜炎（PVE）是TAVR术后一种罕见但令人担忧的并发症，据报道第一年发病率在0.57%至3.1%之间。本研究旨在深入了解荷兰TAVR术后PVE的发病率和结局。
进行了一项多中心回顾性登记研究。对2010年至2017年期间接受TAVR的所有患者在保险数据库中筛查感染性心内膜炎的诊断，并在分析一般特征、PVE参数和结局之前检查是否存在PVE。
共筛查了3968例接受TAVR的患者是否患有PVE。在中位随访33.5个月（四分位间距（IQR）22.8 - 45.8）期间，16例患者发生PVE（0.4%），发病中位时间为177天（IQR 67.8 - 721.3）。第一年发病率为0.24%，总发病率为每1000人年0.14例。在我们的研究中，随访期间的总死亡率为31%，其中25%发生在医院。所有患者仅接受静脉抗生素保守治疗，无人接受再次干预。5例患者（31%）出现PVE的其他并发症,包括主动脉脓肿（2例）、失代偿性心力衰竭（2例）和脑栓塞（1例）。
接受TAVR的患者发生PVE是一种相对罕见的并发症，且死亡率较高。
