Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

Norman Mangner; David del Val; Mohamed Abdel-Wahab; Lisa Crusius; 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; Howard C. Herrmann; Luca Testa; Won Keun Kim; Juan Carlos Castillo; Alberto Alperi; Didier Tchetche; Antonio L. Bartorelli; Samir Kapadia; Stefan Stortecky; Ignacio Amat-Santos; Harindra C. Wijeysundera; John Lisko; Enrique Gutiérrez-Ibanes; Vicenç Serra; Luisa Salido; Abdullah Alkhodair; Ugolino Livi; Tarun Chakravarty; Stamatios Lerakis; Victoria Vilalta; Ander Regueiro; Rafael Romaguera; Utz Kappert; Marco Barbanti; Jean Bernard Masson; Frédéric Maes; Claudia Fiorina; Antonio Miceli; Susheel Kodali; Henrique B. Ribeiro; Jose Armando Mangione; Fabio Sandoli de Brito; Guglielmo Mario Actis Dato; Francesco Rosato; Maria Cristina Ferreira; Valter Correia de Lima; Alexandre Siciliano Colafranceschi; Alexandre Abizaid; Marcos Antonio Marino; Vinicius Esteves; Julio Andrea; Roger R. Godinho; Fernando Alfonso; Helene Eltchaninoff; Lars Søndergaard; Dominique Himbert; Oliver Husser; Azeem Latib; Hervé Le Breton; Clement Servoz; Isaac Pascual; Saif Siddiqui; Paolo Olivares; Rosana Hernandez-Antolin; John G. Webb; Sandro Sponga; Raj Makkar; Annapoorna S. Kini; Marouane Boukhris; Philippe Gervais; Mélanie Côté; David Holzhey; Axel Linke; Josep Rodés-Cabau

doi:10.1016/j.jacc.2021.11.056

Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

Norman Mangner, David del Val, Mohamed Abdel-Wahab, Lisa Crusius, 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, Howard C. HerrmannLuca Testa, Won Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Mélanie Côté, David Holzhey, Axel Linke, Josep Rodés-Cabau

Medicine

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HR_unadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HR_unadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HR_adj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HR_adj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients’ characteristics, pathogen, and IE-related complications.

Original language	English (US)
Pages (from-to)	772-785
Number of pages	14
Journal	Journal of the American College of Cardiology
Volume	79
Issue number	8
DOIs	https://doi.org/10.1016/j.jacc.2021.11.056
State	Published - Mar 1 2022

Keywords

TAVI
antibiotics
cardiac surgery
infective endocarditis
outcome

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2021.11.056

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Mangner, N., Val, D. D., Abdel-Wahab, M., Crusius, L., Durand, E., Ihlemann, N., Urena, M., Pellegrini, C., Giannini, F., Gasior, T., Wojakowski, W., Landt, M., Auffret, V., Sinning, J. M., Cheema, A. N., Nombela-Franco, L., Chamandi, C., Campelo-Parada, F., Munoz-Garcia, E., ... Rodés-Cabau, J. (2022). Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. Journal of the American College of Cardiology, 79(8), 772-785. https://doi.org/10.1016/j.jacc.2021.11.056

Mangner, N, Val, DD, Abdel-Wahab, M, Crusius, L, Durand, E, Ihlemann, N, Urena, M, Pellegrini, C, Giannini, F, Gasior, T, Wojakowski, W, Landt, M, Auffret, V, Sinning, JM, Cheema, AN, Nombela-Franco, L, Chamandi, C, Campelo-Parada, F, Munoz-Garcia, E, Herrmann, HC, Testa, L, Kim, WK, Castillo, JC, Alperi, A, Tchetche, D, Bartorelli, AL, Kapadia, S, Stortecky, S, Amat-Santos, I, Wijeysundera, HC, Lisko, J, Gutiérrez-Ibanes, E, Serra, V, Salido, L, Alkhodair, A, Livi, U, Chakravarty, T, Lerakis, S, Vilalta, V, Regueiro, A, Romaguera, R, Kappert, U, Barbanti, M, Masson, JB, Maes, F, Fiorina, C, Miceli, A, Kodali, S, Ribeiro, HB, Mangione, JA, Sandoli de Brito, F, Actis Dato, GM, Rosato, F, Ferreira, MC, Correia de Lima, V, Colafranceschi, AS, Abizaid, A, Marino, MA, Esteves, V, Andrea, J, Godinho, RR, Alfonso, F, Eltchaninoff, H, Søndergaard, L, Himbert, D, Husser, O, Latib, A, Le Breton, H, Servoz, C, Pascual, I, Siddiqui, S, Olivares, P, Hernandez-Antolin, R, Webb, JG, Sponga, S, Makkar, R, Kini, AS, Boukhris, M, Gervais, P, Côté, M, Holzhey, D, Linke, A & Rodés-Cabau, J 2022, 'Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation', Journal of the American College of Cardiology, vol. 79, no. 8, pp. 772-785. https://doi.org/10.1016/j.jacc.2021.11.056

@article{38b73fbc66c3424ea357fe6eb7d36f79,

title = "Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation",

abstract = "Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients{\textquoteright} characteristics, pathogen, and IE-related complications.",

keywords = "TAVI, antibiotics, cardiac surgery, infective endocarditis, outcome",

author = "Norman Mangner and Val, {David del} and Mohamed Abdel-Wahab and Lisa Crusius and Eric Durand and Nikolaj Ihlemann and Marina Urena and Costanza Pellegrini and Francesco Giannini and Tomasz Gasior and Wojtek Wojakowski and Martin Landt and Vincent Auffret and Sinning, {Jan Malte} and Cheema, {Asim N.} and Luis Nombela-Franco and Chekrallah Chamandi and Francisco Campelo-Parada and Erika Munoz-Garcia and Herrmann, {Howard C.} and Luca Testa and Kim, {Won Keun} and Castillo, {Juan Carlos} and Alberto Alperi and Didier Tchetche and Bartorelli, {Antonio L.} and Samir Kapadia and Stefan Stortecky and Ignacio Amat-Santos and Wijeysundera, {Harindra C.} and John Lisko and Enrique Guti{\'e}rrez-Ibanes and Vicen{\c c} Serra and Luisa Salido and Abdullah Alkhodair and Ugolino Livi and Tarun Chakravarty and Stamatios Lerakis and Victoria Vilalta and Ander Regueiro and Rafael Romaguera and Utz Kappert and Marco Barbanti and Masson, {Jean Bernard} and Fr{\'e}d{\'e}ric Maes and Claudia Fiorina and Antonio Miceli and Susheel Kodali and Ribeiro, {Henrique B.} and Mangione, {Jose Armando} and {Sandoli de Brito}, Fabio and {Actis Dato}, {Guglielmo Mario} and Francesco Rosato and Ferreira, {Maria Cristina} and {Correia de Lima}, Valter and Colafranceschi, {Alexandre Siciliano} and Alexandre Abizaid and Marino, {Marcos Antonio} and Vinicius Esteves and Julio Andrea and Godinho, {Roger R.} and Fernando Alfonso and Helene Eltchaninoff and Lars S{\o}ndergaard and Dominique Himbert and Oliver Husser and Azeem Latib and {Le Breton}, Herv{\'e} and Clement Servoz and Isaac Pascual and Saif Siddiqui and Paolo Olivares and Rosana Hernandez-Antolin and Webb, {John G.} and Sandro Sponga and Raj Makkar and Kini, {Annapoorna S.} and Marouane Boukhris and Philippe Gervais and M{\'e}lanie C{\^o}t{\'e} and David Holzhey and Axel Linke and Josep Rod{\'e}s-Cabau",

note = "Funding Information: Dr Mangner has received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, Bayer, Abbott, Abiomed, and Boston Scientific, outside the submitted work. Dr del Val was supported by a research grant from the Fundaci{\'o}n Alfonso Martin Escudero (Madrid, Spain). Dr Tchetche has received consulting fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Edwards Lifesciences and Medtronic. Dr Webb has received consulting fees from Edwards Lifesciences and St. Jude Medical. Dr Makkar has received research grants from Edwards Lifesciences, Medtronic, Abbott, Capricor, and St. Jude Medical; has served as a proctor for Edwards Lifesciences; and has received consulting fees from Medtronic. Dr de Brito has received honoraria from Medtronic and Edwards Lifesciences for symposium speeches and proctoring cases. Dr Lerakis has received consulting fees from Edwards Lifesciences. Dr Le Breton has received lecture fees from Edwards Lifesciences, outside the submitted work. Dr Sinning has received speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside the submitted work. Dr Kim has received proctor/speaker fees/served on the advisory board for Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, Meril Life Sciences, and Shockwave Medical, outside the submitted work. Dr Stortecky has received grants to the institution from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and has received personal fees from Boston Scientific, BTG, and Teleflex, outside the submitted work. Dr S{\o}ndergaard has received consultant fees and/or institutional research grants from Abbott, Boston Scientific, Medtronic, and SMT. Dr Husser has received personal fees from Boston Scientific; and payments from Abbott. Dr Linke has received personal fees from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, AstraZeneca, Novartis, Pfizer, Abiomed, Bayer, and Boehringer outside the submitted work. Dr Rod{\'e}s-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The authors thank Alfonso Muriel, MD, PhD, from the Clinical Biostatistics Unit, Hospital Ram{\'o}n y Cajal (Madrid, Spain) and Juan Manuel Monteagudo, MD, from the Cardiology Department, Hospital Ram{\'o}n y Cajal (Madrid, Spain) for their statistical advice. Dr Rod{\'e}s-Cabau holds the Research Chair “Fondation Famille Jacques Larivi{\`e}re” for the Development of Structural Heart Disease Interventions. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = mar,

day = "1",

doi = "10.1016/j.jacc.2021.11.056",

language = "English (US)",

volume = "79",

pages = "772--785",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "8",

}

TY - JOUR

T1 - Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

AU - Mangner, Norman

AU - Val, David del

AU - Abdel-Wahab, Mohamed

AU - Crusius, Lisa

AU - Durand, Eric

AU - Ihlemann, Nikolaj

AU - Urena, Marina

AU - Pellegrini, Costanza

AU - Giannini, Francesco

AU - Gasior, Tomasz

AU - Wojakowski, Wojtek

AU - Landt, Martin

AU - Auffret, Vincent

AU - Sinning, Jan Malte

AU - Cheema, Asim N.

AU - Nombela-Franco, Luis

AU - Chamandi, Chekrallah

AU - Campelo-Parada, Francisco

AU - Munoz-Garcia, Erika

AU - Herrmann, Howard C.

AU - Testa, Luca

AU - Kim, Won Keun

AU - Castillo, Juan Carlos

AU - Alperi, Alberto

AU - Tchetche, Didier

AU - Bartorelli, Antonio L.

AU - Kapadia, Samir

AU - Stortecky, Stefan

AU - Amat-Santos, Ignacio

AU - Wijeysundera, Harindra C.

AU - Lisko, John

AU - Gutiérrez-Ibanes, Enrique

AU - Serra, Vicenç

AU - Salido, Luisa

AU - Alkhodair, Abdullah

AU - Livi, Ugolino

AU - Chakravarty, Tarun

AU - Lerakis, Stamatios

AU - Vilalta, Victoria

AU - Regueiro, Ander

AU - Romaguera, Rafael

AU - Kappert, Utz

AU - Barbanti, Marco

AU - Masson, Jean Bernard

AU - Maes, Frédéric

AU - Fiorina, Claudia

AU - Miceli, Antonio

AU - Kodali, Susheel

AU - Ribeiro, Henrique B.

AU - Mangione, Jose Armando

AU - Sandoli de Brito, Fabio

AU - Actis Dato, Guglielmo Mario

AU - Rosato, Francesco

AU - Ferreira, Maria Cristina

AU - Correia de Lima, Valter

AU - Colafranceschi, Alexandre Siciliano

AU - Abizaid, Alexandre

AU - Marino, Marcos Antonio

AU - Esteves, Vinicius

AU - Andrea, Julio

AU - Godinho, Roger R.

AU - Alfonso, Fernando

AU - Eltchaninoff, Helene

AU - Søndergaard, Lars

AU - Himbert, Dominique

AU - Husser, Oliver

AU - Latib, Azeem

AU - Le Breton, Hervé

AU - Servoz, Clement

AU - Pascual, Isaac

AU - Siddiqui, Saif

AU - Olivares, Paolo

AU - Hernandez-Antolin, Rosana

AU - Webb, John G.

AU - Sponga, Sandro

AU - Makkar, Raj

AU - Kini, Annapoorna S.

AU - Boukhris, Marouane

AU - Gervais, Philippe

AU - Côté, Mélanie

AU - Holzhey, David

AU - Linke, Axel

AU - Rodés-Cabau, Josep

N1 - Funding Information: Dr Mangner has received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, Bayer, Abbott, Abiomed, and Boston Scientific, outside the submitted work. Dr del Val was supported by a research grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). Dr Tchetche has received consulting fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Edwards Lifesciences and Medtronic. Dr Webb has received consulting fees from Edwards Lifesciences and St. Jude Medical. Dr Makkar has received research grants from Edwards Lifesciences, Medtronic, Abbott, Capricor, and St. Jude Medical; has served as a proctor for Edwards Lifesciences; and has received consulting fees from Medtronic. Dr de Brito has received honoraria from Medtronic and Edwards Lifesciences for symposium speeches and proctoring cases. Dr Lerakis has received consulting fees from Edwards Lifesciences. Dr Le Breton has received lecture fees from Edwards Lifesciences, outside the submitted work. Dr Sinning has received speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside the submitted work. Dr Kim has received proctor/speaker fees/served on the advisory board for Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, Meril Life Sciences, and Shockwave Medical, outside the submitted work. Dr Stortecky has received grants to the institution from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and has received personal fees from Boston Scientific, BTG, and Teleflex, outside the submitted work. Dr Søndergaard has received consultant fees and/or institutional research grants from Abbott, Boston Scientific, Medtronic, and SMT. Dr Husser has received personal fees from Boston Scientific; and payments from Abbott. Dr Linke has received personal fees from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, AstraZeneca, Novartis, Pfizer, Abiomed, Bayer, and Boehringer outside the submitted work. Dr Rodés-Cabau has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The authors thank Alfonso Muriel, MD, PhD, from the Clinical Biostatistics Unit, Hospital Ramón y Cajal (Madrid, Spain) and Juan Manuel Monteagudo, MD, from the Cardiology Department, Hospital Ramón y Cajal (Madrid, Spain) for their statistical advice. Dr Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/3/1

Y1 - 2022/3/1

N2 - Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients’ characteristics, pathogen, and IE-related complications.

AB - Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients’ characteristics, pathogen, and IE-related complications.

KW - TAVI

KW - antibiotics

KW - cardiac surgery

KW - infective endocarditis

KW - outcome

UR - http://www.scopus.com/inward/record.url?scp=85124390143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85124390143&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.11.056

DO - 10.1016/j.jacc.2021.11.056

M3 - Article

C2 - 35210032

AN - SCOPUS:85124390143

SN - 0735-1097

VL - 79

SP - 772

EP - 785

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 8

ER -

Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

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