Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement |
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| Authors: | David del Val Mohamed Abdel-Wahab Norman Mangner Eric Durand Nikolaj Ihlemann Marina Urena Costanza Pellegrini Francesco Giannini Tomasz Gasior Wojtek Wojakowski Martin Landt Vincent Auffret Jan Malte Sinning Asim N. Cheema Luis Nombela-Franco Chekrallah Chamandi Francisco Campelo-Parada Erika Munoz-Garcia Josep Rodés-Cabau |
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| Affiliation: | 1. Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy;2. Invasive Cardiology Unit, “Pineta Grande” Hospital, Caserta, Italy;3. Cardiothoracic and Vascular Department, University Hospital Pisa, Italy;4. Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Massa, Italy;5. UOSA Cardiologia Interventistica, Dipartimento di Scienze Cardiache, Toraciche e Vascolari, Azienda Ospedaliera Universitaria, Siena, Italy;6. Department of Invasive Cardiology, Casa di Salute “Santa Lucia”, San Giuseppe Vesuviano, Napoli, Italy;7. Centro Cardiologico Monzino, IRCCS, Milan, Italy;8. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy;9. Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy;10. Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy;11. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;12. Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy;13. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy;14. Mediterranea Cardiocentro, Napoli, Italy |
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| Abstract: | BackgroundStroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR).ObjectivesThe purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization.MethodsData from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]).ResultsA total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47).ConclusionsStroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes. |
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| Keywords: | infective endocarditis prosthetic valve endocarditis stroke TAVR transcatheter aortic valve implantation AR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" aortic regurgitation HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" hazard ratio IE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" infective endocarditis IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" interquartile range NS-IE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" no stroke in patients with infective endocarditis OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" odds ratio PVE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" prosthetic-valve endocarditis S-IE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" stroke in patients with infective endocarditis TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement |
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