Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Clin Res Cardiol. 2024 Feb;113(2):336-352. doi: 10.1007/s00392-023-02356-4. Epub 2024 Jan 3.
Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI).
All patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE.
PVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9% vs. 33.3%; p = 0.005). In SAVR-PVE patients, both therapies were comparable in terms of survival (p = 0.861). However, SAVR-PVE patients who were not operated, despite ESC-guideline recommendation, had significantly poorer one-year survival (p = 0.004).
TAVI patients did not have a significantly higher risk to develop PVE. Our data suggest that TAVI-PVE patients in contrast to SAVR-PVE patients can more often be treated with antibiotics only, presumably due to the lack of a polymeric suture ring.
人工心脏瓣膜心内膜炎（PVE）是主动脉瓣置换术后预后最差的并发症。本研究旨在更好地了解经外科（SAVR）和经导管主动脉瓣置换术（TAVI）后 PVE 的不同病理和治疗方面。
分析 2012 年 1 月至 2018 年 12 月期间在本中心接受单纯 SAVR（n=3447）或 TAVI（n=2269）的所有患者。PVE 的诊断基于 2015 年改良的杜克标准。分析和比较了 SAVR-PVE 和 TAVI-PVE 之间的发生率、危险因素、病原体、并发症或治疗对死亡率的影响。
SAVR 后 PVE 的发生率无显著差异，为 4.9/100 患者年，TAVI 后为 2.4/100 患者年（p=0.49），尽管 TAVI 患者年龄较大（平均 80 岁 vs. 67 岁），合并症更多（STS 评分平均 5.9 分 vs. 1.6 分）（p<0.001）。与无聚合物的 TAVI 瓣膜相比，聚合物瓣膜发生 PVE 的风险高 4.3 倍（HR 4.3；p=0.004）。最常见的病原体是葡萄球菌和肠球菌（p>0.05）。倾向评分匹配分析显示，主动脉瓣置换类型对术后 PVE 的发生无影响（p=0.997）。与单纯抗生素治疗相比，仅接受抗生素治疗的 TAVI-PVE 患者的 1 年生存率更高（90.9% vs. 33.3%；p=0.005）。在 SAVR-PVE 患者中，两种治疗方法的生存率相当（p=0.861）。然而，尽管 ESC 指南建议，但未接受手术的 SAVR-PVE 患者的 1 年生存率明显较差（p=0.004）。
TAVI 患者发生 PVE 的风险无显著升高。我们的数据表明，与 SAVR-PVE 患者相比，TAVI-PVE 患者更常仅接受抗生素治疗，这可能是由于缺乏聚合物缝线环。
