Alabbadi Sundos H, Iribarne Alexander, Rodés-Cabau Josep, Doenst Torsten, Chikwe Joanna, Itagaki Shinobu, Toyoda Nana, Makkar Raj, Akowuah Enoch F, Perez Marissa, Bandettini W Patricia, Akhter Shahab A, Bleiziffer Sabine, Krane Markus, Makhija Hirsh, Deshpande Ranjit, Gelijns Annetine C, Egorova Natalia N
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
Department of Cardiothoracic Surgery, Staten Island University Hospital/Northwell Health, Staten Island, NY, 10305, United States.
Eur J Cardiothorac Surg. 2025 Aug 2;67(8). doi: 10.1093/ejcts/ezaf274.
Despite increased use of transcatheter aortic valve implantation (TAVI) in older adults with severe aortic stenosis, contemporary data on infective endocarditis (IE)-an infrequent but serious complication-are lacking. This study addresses this gap in knowledge.
We analysed 280 073 Medicare beneficiaries who underwent TAVI between 2013 and 2022. The primary outcome was the change in the 1-year incidence rate of IE post-TAVI. Joinpoint regression was used to evaluate the trend in the IE incidence as annual percent change (APC). Adjusted Cox models were used to evaluate associations between IE incidence and patient characteristics, as well as 12-month outcomes.
The incidence rate of IE 1 year post-TAVI decreased from 20.0/1000 person-years in 2013 to 13.1/1000 in 2021. There was no change in incidence between 2013 and 2018 but a significant decline thereafter (-12.1% [CI, -20.7% to -7.5%], P < .001). This decline was associated with the decrease in non-elective TAVI (sub-distribution hazard ratio: 0.98 [CI, 0.94-0.99], P < .001); 4.8% of patients with IE underwent aortic valve reintervention. The 30-day aortic valve reintervention rate after IE increased significantly from 2013 to 2022 (APC: 24.9% [CI, 17.2%-33.0%], P < .001). The 30-day mortality rate after TAVI explant was 9.3%; the adjusted risk of death declined over time (HR: 0.73 [CI, 0.58-0.92], P = .01). However, the overall 30-day risk-adjusted mortality rate of TAVI-IE remained unchanged.
The post-TAVI incidence of IE in Medicare patients decreased after 2019. This decrease was associated with declining rates of non-elective TAVI and coincided with FDA approval of TAVI for low-risk patients. TAVI explant rates were low but increased recently. The lack of improvement in 30-day mortality underscores the challenges of elderly care after TAVI.
尽管经导管主动脉瓣植入术（TAVI）在老年重度主动脉瓣狭窄患者中的应用有所增加，但关于感染性心内膜炎（IE）这一罕见但严重并发症的当代数据仍然缺乏。本研究填补了这一知识空白。
我们分析了2013年至2022年间接受TAVI的280073名医疗保险受益人。主要结局是TAVI术后1年IE发病率的变化。采用Joinpoint回归评估IE发病率的趋势，以年度百分比变化（APC）表示。使用校正后的Cox模型评估IE发病率与患者特征以及12个月结局之间的关联。
TAVI术后1年IE发病率从2013年的20.0/1000人年降至2021年的13.1/1000。2013年至2018年发病率无变化，但此后显著下降（-12.1%[CI，-20.7%至-7.5%]，P＜0.001）。这种下降与非选择性TAVI率的降低有关（亚分布风险比：0.98[CI，0.94-0.99]），P＜0.001）；4.8%的IE患者接受了主动脉瓣再次干预。2013年至2022年，IE后30天主动脉瓣再次干预率显著增加（APC：24.9%[CI，17.2%-33.0%]，P＜0.001）。TAVI取出术后30天死亡率为9.3%；校正后的死亡风险随时间下降（HR：0.73[CI，0.58-0.92]，P = 0.01）。然而，TAVI-IE的总体30天风险校正死亡率保持不变。
2019年后，医疗保险患者TAVI术后IE发病率下降。这种下降与非选择性TAVI率的下降有关，并且恰逢FDA批准TAVI用于低风险患者。TAVI取出率较低，但最近有所增加。30天死亡率没有改善凸显了TAVI术后老年护理的挑战。
