Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement

Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison wi...

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Vydáno v:Journal of the American College of Cardiology Ročník 73; číslo 13; s. 1646
Hlavní autoři: Butt, Jawad H, Ihlemann, Nikolaj, De Backer, Ole, Søndergaard, Lars, Havers-Borgersen, Eva, Gislason, Gunnar H, Torp-Pedersen, Christian, Køber, Lars, Fosbøl, Emil L
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 09.04.2019
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ISSN:1558-3597, 1558-3597
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Abstract Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR. This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR. In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries. A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49). The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.
AbstractList Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR. This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR. In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries. A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49). The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.
Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.BACKGROUNDPatients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.OBJECTIVESThis study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.METHODSIn this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).RESULTSA total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.CONCLUSIONSThe 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.
Author Butt, Jawad H
Ihlemann, Nikolaj
Gislason, Gunnar H
De Backer, Ole
Havers-Borgersen, Eva
Fosbøl, Emil L
Søndergaard, Lars
Køber, Lars
Torp-Pedersen, Christian
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  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: jawad_butt91@hotmail.com
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  surname: Ihlemann
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  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  givenname: Ole
  surname: De Backer
  fullname: De Backer, Ole
  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  givenname: Lars
  surname: Søndergaard
  fullname: Søndergaard, Lars
  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  givenname: Gunnar H
  surname: Gislason
  fullname: Gislason, Gunnar H
  organization: Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark; National Institute of Public Health, University of Southern Denmark, Odense, Denmark
– sequence: 7
  givenname: Christian
  surname: Torp-Pedersen
  fullname: Torp-Pedersen, Christian
  organization: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
– sequence: 8
  givenname: Lars
  surname: Køber
  fullname: Køber, Lars
  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
– sequence: 9
  givenname: Emil L
  surname: Fosbøl
  fullname: Fosbøl, Emil L
  organization: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30947917$$D View this record in MEDLINE/PubMed
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infective endocarditis
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SubjectTerms Aged
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Denmark - epidemiology
Endocarditis - epidemiology
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Female
Follow-Up Studies
Humans
Incidence
Male
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - mortality
Title Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement
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