Developing infective endocarditis following TAVR is associated with high mortality rates

Patients who developed infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR) had high rates of morbidity and mortality, according to a registry analysis. The in-hospital mortality rate was 36 percent, while the two-year mortality rate was 66.7 percent.

The researchers also found that the following factors were significantly associated with an increased risk of infective endocarditis following TAVR: younger age, male sex, history of diabetes and moderate to severe residual aortic regurgitation.

Lead researcher Ander Regueiro, MD, of the Quebec Heart & Lung Institute and Laval University in Canada, and colleagues published their results online in JAMA Sept. 13.

Previous studies found that approximately 1.5 percent of patients developed infective endocarditis within a year following TAVR.

For this analysis, the researchers analyzed a registry that retrospectively collected data on 250 cases of patients diagnosed with infective endocarditis after TAVR from 47 sites in Europe, North America and South America between June 2005 and October 2015.

At baseline, the median age was 80 years old, while 63.6 percent of patients were men. There were a total of 20,006 patients in the registry.

During the study, the incidence rate of infective endocarditis was 1.1 percent per person-year. The median time between TAVR and the first symptoms was 5.3 patients.

The researchers mentioned that 178 patients developed infective endocarditis within a year following TAVR, including 72 who were diagnosed with the condition within two months of the procedure.

They assessed factors associated with infective endocarditis after TAVR in a subset of 6,398 patients, including 108 who developed infective endocarditis. They found that patients who developed infective endocarditis had a mean age of 78.9 years compared with 81.8 years for those who did not develop the condition.

Patients who developed infective endocarditis were also more likely to be male, have diabetes, have diabetes and have moderate to severe aortic regurgitation. In addition, 14.8 percent of patients underwent surgery during their infective endocarditis episode.

The researchers added that in-hospital mortality was associated with a higher logistic EuroSCORE, heart failure and acute kidney injury.

They also mentioned the study had a few limitations, including that they analyzed a retrospective registry and did not have an external monitoring or event adjudication committee that verified the accuracy of the data. They also said that the confounding factors not included in their multivariable models could have affected the results.