Background:
Infectious endocarditis (IE) is a known complication after transcatheter aortic valve implantation (TAVI). Available data suggest that IE was infrequent after TAVI but was associated with substantial mortality. We sought to determine the 6-month incident rates and outcomes of this complication after TAVI in the United States representative patient population.
Methods:
A weighted sample of adult patients who underwent TAVI and survived to discharge were identified in the Nationwide Readmissions Database January to June 2014 using appropriate ICD-9 codes. Among these patients, readmissions within 180-days in which IE was diagnosed were identified. Microbiology, complications, valvular procedural utilization, and mortality with IE were the outcomes studied.
Results:
Of 7,834 patients (mean age 81 years, 52% men) who underwent TAVI during the study period, 61 patients (0.8%; mean age 79 years, 58% men) had IE within 180 days form discharge. Median day to developing IE was 79 days [interquartile range 49-124 days]. Septicemia was present in 43 patients (71%) of which 15 (24%) developed septic shock. Gram positive bacteremia was frequent with 13 patients (21%) having
Streptococcal
bacteremia, and 12 (19%) with
Staphylococcal
bacteremia. Gram negative organisms were identified in 4%. Heart failure developed in 46 patients (75%), respiratory failure in 12 (20%), and acute kidney injury in 18 (29%). Concomitant pneumonia was present in 8 patients (13%). A valvular intervention was not performed in any of the 61 patients and 13 patients (22%) died in-hospital after IE diagnosis.
Conclusions:
Nearly 8 out of every 1000 patients undergoing TAVI developed IE within 6 months post-procedure. IE post TAVI was most commonly caused by gram positive bacteria and was associated with very high rates of multi-system complication. A valvular intervention was not performed in these sick patients with IE, and 1 out of 5 patient who developed IE died.
Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge