Stanford University School of Medicine, Palo Alto, California, USA.
Stanford University School of Medicine, Palo Alto, California, USA.
J Am Coll Cardiol. 2021 Aug 10;78(6):575-589. doi: 10.1016/j.jacc.2021.05.044.
Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication.
The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort.
The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes.
Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus.
The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.
经导管肺动脉瓣置换术（TPVR）后，感染性心内膜炎已成为最具影响力的不良事件之一，但关于该并发症的风险因素和结局的信息有限。
本研究的目的是在一个大型多中心队列中评估感染性心内膜炎的风险因素和结局。
作者建立了一个国际注册处，专注于描述 TPVR 后感染性心内膜炎的特征，包括发病率、风险因素、特征和结局。
研究人员提交了 2476 例患者的数据，这些患者于 2005 年 7 月至 2020 年 3 月间接受了 TPVR 治疗，并随访了 8475 患者年。共有 182 例患者在 TPVR 后中位 2.7 年后被诊断为感染性心内膜炎，5 年时的累积发病率为 9.5%（95%CI：7.9%-11.1%），8 年时为 16.9%（95%CI：14.2%-19.8%）（考虑竞争风险：死亡、心脏移植和瓣膜置换），年发病率为 2.2/100 患者年。金黄色葡萄球菌和草绿色链球菌共占病例的 56%。多变量分析证实，年龄较小、既往感染性心内膜炎史和残余梯度较高是感染性心内膜炎的危险因素，但经导管肺动脉瓣类型不是。总的来说，右心室流出道（RVOT）再次干预治疗感染性心内膜炎的频率低于其他原因，但瓣膜置换更常因感染性心内膜炎引起。44%的患者感染性心内膜炎严重，12 例（6.6%）患者死亡，几乎所有患者均感染金黄色葡萄球菌。
本多中心注册研究的发病率随时间保持不变，与先前较小的研究结果一致。本研究的发现，以及为了解和降低风险而进行的持续努力，对于改善涉及 RVOT 的心脏病患者的终生管理至关重要。尽管感染性心内膜炎可能是一种严重的不良后果，但 TPVR 仍然是治疗 RVOT 功能障碍的重要工具。
