Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Heart Center, Leipzig University, Leipzig, Germany.
Clin Infect Dis. 2022 Sep 10;75(4):638-646. doi: 10.1093/cid/ciab1004.
Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients.
This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula.
A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27-3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57-4.69; P < .001) were associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs 15.2% in patients without PEE, P < .001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj < 0.05 for all).
PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
经导管主动脉瓣置换术（TAVR）后感染性心内膜炎（IE）与预后不良有关。然而，关于此类患者的瓣周延伸（PEE）IE 的数据很少。
这项多中心研究纳入了 579 例 TAVR 后中位时间为 171（53-421）天确诊为明确 IE 的患者。PEE 的定义为存在心内脓肿、假性动脉瘤或瘘管。
共有 105 例（18.1%）患者诊断为 PEE（瓣周脓肿、假性动脉瘤、瘘管或上述几种的组合，分别在 87、7、7 和 4 例患者中发现）。慢性肾脏病病史（校正比值比 [ORadj]，2.08；95%置信区间 [CI]：1.27-3.41；P=0.003）和由凝固酶阴性葡萄球菌引起的 IE（ORadj，2.71；95%CI：1.57-4.69；P<0.001）与 PEE 的发生风险增加相关。34 例 PEE 患者（32.4%）在 IE 首发时接受了手术（而无 PEE 患者中为 15.2%，P<0.001）。PEE-IE 患者的住院期间和 2 年死亡率分别为 36.5%和 69.4%。增加死亡率的独立因素是其他并发症（TAVR 后中风、急性肾衰竭、感染性休克）的发生和 IE 住院期间未行手术（所有因素 P<0.05）。
TAVR 后 IE 患者中约有五分之一发生 PEE，凝固酶阴性葡萄球菌和慢性肾脏病的存在增加了风险。PEE-IE 患者的早期和晚期死亡率较高，IE 住院期间行手术似乎与更好的结局相关。
