Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Clin Infect Dis. 2021 Dec 6;73(11):e3750-e3758. doi: 10.1093/cid/ciaa1941.
Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR.
Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014).
Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all).
Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.
经导管主动脉瓣置换术（TAVR）的操作改进和当代患者的临床特征可能影响了 TAVR 后感染性心内膜炎（IE）的发生率和结局。我们旨在确定 TAVR 后 IE 的时间趋势、特征和结局。
本研究为一项包括 552 例确诊 TAVR 后 IE 患者的观察性研究。根据 TAVR 时间将患者分为两组（历史队列[HC]：2014 年前；当代队列[CC]：2014 年后）。
两组的 IE 总发生率相似（CC 比 HC：5.45 比 6.52/1000 人年；P=0.12），但 CC 的早期 IE 发生率较低（2.29‰比 4.89‰，P<0.001）。肠球菌是最常见的微生物。大多数患者表现为复杂的 IE（CC：67.7%；HC：69.6%；P=0.66），但手术治疗率仍较低（CC：20.7%；HC：17.3%；P=0.32）。CC 的院内急性肾损伤（35.1%比 44.6%；P=0.036）、院内（26.6%比 36.4%；P=0.016）和 1 年（37.8%比 53.5%；P<0.001）死亡率较低。多变量分析显示，较高的 logistic EuroScore、金黄色葡萄球菌病因和并发症（中风、心力衰竭和急性肾衰竭）与院内死亡率相关（所有 P<0.05）。
尽管 IE 的总体发生率保持稳定，但近年来早期 IE 的发生率有所下降。微生物、高并发症发生率和极低的手术治疗率仍然相似。院内和 1 年死亡率较高，但随着时间的推移逐渐下降。
