Comparison of Incidence, Predictors, and Outcomes of Early Infective Endocarditis after Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in the United States
Autor: | Dhaval Kolte, Afshin Ehsan, Kevin F. Kennedy, Frank W. Sellke, Herbert D. Aronow, Barry L. Sharaf, Andrew M. Goldsweig, Paul C. Gordon, J. Dawn Abbott, Neel R. Sodha |
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Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_specialty Prosthesis-Related Infections Time Factors 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aortic valve replacement Risk Factors Interquartile range Internal medicine medicine Humans Hospital Mortality 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Endocarditis business.industry Incidence Incidence (epidemiology) Mortality rate Retrospective cohort study Aortic Valve Stenosis Prognosis medicine.disease United States Survival Rate Aortic Valve Infective endocarditis Cohort Cardiology Female Cardiology and Cardiovascular Medicine Complication business Follow-Up Studies |
Zdroj: | The American Journal of Cardiology. 122:2112-2119 |
ISSN: | 0002-9149 |
Popis: | Infective endocarditis (IE) of prosthetic or bioprosthetic heart valves is a serious complication associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after transcatheter aortic valve implantation (TAVI) in the United States are limited. We used the 2013 to 2014 Nationwide Readmissions Databases to determine the incidence of early IE after TAVI and surgical aortic valve replacement (SAVR) in the US. Clinical characteristics, independent predictors, and outcomes of patients with IE post-TAVI were examined. In 29,306 TAVI and 66,077 SAVR patients, the incidence rates of early IE were 1.7% (95% confidence interval [CI] 1.5% to 1.9%) and 2.5% (95% CI 2.3% to 2.9%) per person-year, respectively. In a propensity-matched cohort of 15,138 TAVI and 15,030 SAVR patients (weighted), there were no significant differences in the incidence rates of IE (1.7% [95% CI 1.4% to 2.0%] vs 1.9% [95% CI 1.6% to 2.2%] per person-year, log-rank p = 0.29) or in the median (interquartile range) time to IE (91 [48 to 146] vs 92 [61 to 214] days, p = 0.13). Staphylococcus (30.4%), Streptococcus (29.9%), and Enterococcus (20.5%) were the most common causative organisms of IE post-TAVI. Younger age, history of heart failure, need for permanent pacemaker placement, cardiac arrest, major bleeding, and sepsis during the index TAVI hospitalization were independently associated with an increased risk of IE. In-hospital mortality rate during readmission for IE was 15.6%. In conclusion, in a nationally representative cohort of TAVI patients in the US, the incidence rate of early IE was 1.7% per person-year. Age, co-morbid conditions, invasive procedures, and complications during the index hospitalization were associated with incident IE post-TAVI. |
Databáze: | OpenAIRE |
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