Abstract 19639: Infective Endocarditis Following Transcatheter Valve Implantation: A Systematic Review

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ignacio J Amat-Santos ◽  
Henrique B Ribeiro ◽  
Marina Urena ◽  
Ricardo Allende ◽  
Cristine Houde ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
High Risk ◽  
Hospital Mortality ◽  
Risk Profile ◽  
Electronic Search ◽  
Transcatheter Valve ◽  
Few Data ◽  
Valve Implantation ◽  
Transcatheter Valves ◽  
Very High

Objectives: To describe the incidence, features, predisposing factors and outcomes of infective endocarditis (IE) following transcatheter valve implantation (TVI). Background: Very few data exist on IE following TVI. Methods: Studies published between 2000 and 2013 regarding IE in patients with aortic (TAVI) or pulmonary (TPVI) transcatheter valves were identified through systematic electronic search. Result: A total of 28 publications describing 60 patients (32 TAVI, 28 TPVI) were identified. Most TAVI patients (66% males, 80±7 years) had a very high-risk profile (LogEuroSCORE: 30.4±14.0%, p<0.001 compared to previous TAVI registries). In TPVI patients (90% males, 19±6 years), IE was more frequent in stenotic conduit/valve (61%) (p <0.001 vs. previous TPVI series). Median time between TVI and IE was 5.5 (2-12) months. Typical microorganisms were mostly found with a higher incidence of enterococci after TAVI (34.4% vs. 0%, p =0.009), and S.aureus after TPVI (29.4% vs. 6.2%, p =0.041). Up to 60% of the TAVI-IE patients were managed medically despite related complications such as local extension, embolism and/or heart failure in >50% of patients. Valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively (p=0.07). In-hospital mortality for TAVI-IE was 34.4%. Most TPVI-IE patients (75%) were managed surgically, and in-hospital mortality was 7.1%. Conclusions: Most cases of IE post-TVI were males, with a very high-risk profile (TAVI) or underlying stenotic conduit/valve (TPVI). Typical -but different- microorganisms of IE were involved in half of the TAVI and TPVI cases. Most TPVI-IE patients were managed surgically as opposed to TAVI patients, and mortality rate was high in both cohorts.

scholarly journals Expert Opinion: Will PARTNER 2 Change My Practice?

2017 ◽  
Vol 12 (02) ◽  
pp. 126 ◽  
Author(s):  
Fadi J Sawaya ◽  
Lars Søndergaard ◽  
◽  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Risk Groups ◽  
Risk Profile ◽  
Surgical Aortic Valve Replacement ◽  
The Past ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation ◽  
New Generation ◽  
Transcatheter Valves

Transcatheter aortic valve implantation (TAVI) has become an established and increasingly-used technique to treat patients with severe aortic valve stenosis (AS) over the past decade. The clinical outcomes obtained with TAVI have been found to be equivalent to surgical aortic valve replacement (SAVR) in patients with a high-risk profile. Following the Placement of Aortic Transcatheter Valves (PARTNER) 1 trial, which demonstrated the utility of TAVI in inoperable and high-risk groups, the PARTNER 2 trial was implemented. PARTNER 2 reflects the current TAVI practice in Europe, confirms that transfemoral access is related to superior outcomes compared to SAVR in a selected population and demonstrates improved results with new-generation devices.

scholarly journals A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

2019 ◽  
Vol 8 (2) ◽  
pp. 252 ◽  
Author(s):  
Miguel de Araújo Nobre ◽  
Francisco Salvado ◽  
Paulo Nogueira ◽  
Evangelista Rocha ◽  
Peter Ilg ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Score ◽  
Disease Risk ◽  
Disease Incidence ◽  
Risk Groups ◽  
Risk Profile ◽  
Moderate Risk ◽  
C Statistic ◽  
Disease Risk Score ◽  
Very High

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

scholarly journals Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hussein Hassan Rizk ◽  
Ahmed Adel Elamragy ◽  
Ghada Sayed Youssef ◽  
Marwa Sayed Meshaal ◽  
Ahmad Samir ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Facility ◽  
Period 2 ◽  
Peripheral Embolization ◽  
Tertiary Care Facility ◽  
Few Data ◽  
Healthcare Associated ◽  
Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

scholarly journals SHARPEN score accurately predict in-hospital mortality in infective endocarditis: a real-world validation study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.G Alves ◽  
F.B Filippini ◽  
G.P Dannenhauer ◽  
G Seroiska ◽  
L.F.S Birk ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cardiac Surgery ◽  
Infective Endocarditis ◽  
High Risk ◽  
Hospital Mortality ◽  
Rank Test ◽  
C Statistic ◽  
Kaplan Meier ◽  
Duke Criteria ◽  
High Negative Predictive Value

Abstract Background Infective Endocarditis (IE) has impressive 30-day mortality of up to 30%. Prompt recognition of high-risk patients is required in order to optimize management and outcomes. The SHARPEN score was recently developed to predict intrahospital mortality in patients admitted due to IE, regardless of the need to undergo cardiac surgery. We aimed to evaluate the accuracy of the SHARPEN score to predict in-hospital mortality in comparison to Charlson Comorbidity Index (CCI). Methods Retrospective cohort of all consecutive adult admissions between 2000 and 2016 with diagnosis of definitive IE according to the Modified Duke Criteria. The SHARPEN score was applied comprising: Systolic blood pressure at presentation, Heart failure, Age, Raised creatinine, Pneumonia, Elevated peak CRP and Non-intravenous drug abuser. The CCI was applied to assess comorbidities. Accuracy in predict mortality was estimated with C-statistic. DeLong test was used to compare the areas under the curve (AUC). Survival probabilities were estimated by Kaplan-Meier method and differences between survival curves analyzed using the log-rank test. Multivariate analysis using Poisson Regression with robust variation was performed to determine independent predictors of in-hospital mortality. Results 179 cases of IE were registered (70% male; 55±17 years-old) with an in-hospital mortality of 22%. Cardiac surgery was required in 68 (38%) of the patients. Calculated SHARPEM and CCI scores were 9 (7–11) and 3 (1–6) points respectively. SHARPEN was able to predict in-hospital mortality with an AUC of 0.76 (95% CI 0.7–0.8; p&lt;0.001) and cut-off &gt;10 points (Sen=69%; Sp=71%; PPV=40%; NPV=89%). Mortality was significant higher (40% vs 11%; p&lt;0.001) in patients with SHARPEN &gt;10 points (FIGURE). CCI had a similar AUC of 0.7 (95% CI 0.6 - 0.8; p&lt;0.001) with SHARPEN (p=0.32). However, in a multivariate analysis, SHARPEN score &gt;10 points a stronger predictor related with in-hospital mortality (OR 2.3; 95% CI 1.1 - 4.8; p=0.03) in comparison to CCI &gt;3 points (OR 1.4; 95% CI 0.7–2.8; p=0.3). Conclusion SHARPEN score demonstrated a good accuracy in predict in-hospital mortality independently of other variables, with a high negative predictive value. These findings suggest that SHARPEN score may be useful to stratify high-risk IE patients in a clinical setting. Funding Acknowledgement Type of funding source: None

scholarly journals Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients

2014 ◽  
Vol 147 (2) ◽  
pp. 561-567 ◽  
Author(s):  
Giuseppe Santarpino ◽  
Steffen Pfeiffer ◽  
Jürgen Jessl ◽  
Angelo Maria Dell’Aquila ◽  
Francesco Pollari ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Valve Implantation

scholarly journals Transcatheter “valve-in-valve” implantation of bioprosthesis in failed surgical tricuspid bioprosthesis (first experience in Russia)

2019 ◽  
pp. 31-37
Author(s):  
T. E. Imaev ◽  
A. E. Komlev ◽  
V. V. Romakina ◽  
P. M. Lepilin ◽  
M. I. Makeev ◽  
...  
Keyword(s):  
High Risk ◽  
Tricuspid Valve ◽  
Long Term Results ◽  
Right Ventricle Dysfunction ◽  
Structural Deterioration ◽  
Risk Patients ◽  
Echocardiographic Parameters ◽  
Transcatheter Valve ◽  
Valve Implantation ◽  
6 Minute Walk Test

Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.

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