Endocarditis after TAVR: Increasingly rare, but incredibly fatal

The incidence of endocarditis after transcatheter aortic valve replacement (TAVR) is “low and declining,” according to a new study published in JACC: Cardiovascular Interventions. However, the authors noted, it is still associated with poor outcomes—nearly half of all patients die within the first year.

“As a result of evidence from the randomized controlled trials, TAVR indications have expanded to include severe aortic stenosis patients with low surgical risk,” wrote lead author Amgad Mentias, MD, MS, University of Iowa Carver College of Medicine in Iowa City, and colleagues. “Given the increasing number of patients who undergo TAVR, it is important to study possible long-term complications after the procedure. As with any intracardiac device or prosthesis, there is a risk of infection and endocarditis in patients who undergo TAVR.”

Mentias’s team tracked data from more than 134,000 Medicare patients who underwent TAVR from 2012 to 2017. Overall, 1.3% of patients developed endocarditis, and 65% of those infections occurred within the first year after TAVR. The authors noted that incidence of endocarditis after TAVR declined over the course of the study. It was 0.54% at the start of the study, for example, and 0.27% at the study’s conclusion.

Thirty-day mortality among patients with endocarditis was 18.5%, and one-year mortality was 45.6%. Endocarditis was associated with a three-fold higher risk of mortality.

Also, the authors observed, young age at the time of TAVR, prior endocarditis before TAVR, end stage renal disease, numerous TAVR procedures, liver disease, lung disease, requiring a blood transfusion after TAVR, atrial fibrillation and acute kidney injury were all identified as predictors of endocarditis after TAVR.

“Given the poor prognosis of endocarditis after TAVR and the limited options for intervention and treatment, patients at high risk should be identified early and efforts should be implemented to prevent the infection,” Mentias and colleagues concluded.

The full JACC: Cardiovascular Interventions analysis is available here.