Regueiro et al identified risk factors associated with infective endocarditis following transcatheter aortic valve replacement (TAVR). These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Europe, North America and South America.
The incidence of infective endocarditis was 1.1% per person-year and was diagnosed in 250 of 20,006 patients. The median time between the procedure and the first symptom was 5.3 months.
Risk factors for infective endocarditis following the procedure:
(1) moderate or severe residual aortic regurgitation (adjusted odds ratio 2.1)
(2) diabetes mellitus (adjusted odds ratio 1.5)
(3) male gender (adjusted odds ratio 1.7)
The risk was lower for older age but the use of this information in an algorithm is limited. The age range for infective endocarditis was 74 to 83 years with mean 80. The age range for patients without infective endocarditis was 78 to 87 years with mean age 83.
Only 1.2% who developed endocarditis had a previous history of endocarditis.
Risk factors for in-hospital mortality in a patient with infective endocarditis following TAVR:
(1) heart failure during infective endocarditis hospital stay (adjusted odds ratio 3.4)
(2) renal failure during infective endocarditis hospital stay (adjusted odds ratio 2.7)
(3) Staphylococcus aureus as causative pathogen (adjusted odds ratio 1.8)
(4) increased logistic EuroSCORE (adjusted odds ratio 1.03 per 1% increase)
The 2-year mortality rate for patients with infective endocarditis after TAVR was 67%.
