Skip to main content

Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials.

Publication ,  Journal Article
Summers, MR; Leon, MB; Smith, CR; Kodali, SK; Thourani, VH; Herrmann, HC; Makkar, RR; Pibarot, P; Webb, JG; Leipsic, J; Alu, MC; Crowley, A ...
Published in: Circulation
December 10, 2019

BACKGROUND: Prosthetic valve endocarditis (PVE) is a rare but critical mechanism of valve failure and death after transcatheter and surgical aortic valve replacement (TAVR, SAVR) warranting further analysis in modern aortic valve replacement experience. We characterize the incidence, risk factors, microbiological profile and outcomes of PVE from the PARTNER trials and registries (Placement of Aortic Transcatheter Valve). METHODS: We analyzed a pooled cohort of all patients in PARTNER 1 and PARTNER 2 trials and registries. Patients had severe aortic stenosis, were treated with TAVR or SAVR, and were analyzed with respect to development of PVE. PVE adjudication by a clinical events committee was based on modified Duke Criteria. The incidence, infection timing, organism, and association between PVE and all-cause mortality were analyzed. RESULTS: 8530 patients were included. PVE occurred in 107 cases (5.06 PVE events per 1000 person-years over a mean follow-up of 2.69±1.55 years [95% CI, 4.19-6.12]). The incidence of TAVR-PVE (5.21 PVE per 1000 person-years [95% CI, 4.26-6.38]) was not significantly different from SAVR-PVE (4.10 per 1000 person-years [95% CI, 2.33-7.22]; incident rate ratio, 1.27 [95% CI, 0.70-2.32]; P=0.44). Temporal risk of PVE was similar for TAVR and SAVR, even after adjusting for competing risk of death (hazard ratio, 1.15 [95% CI, 0.58-2.28]; P=0.69). Through multivariable analysis, PVE was associated with baseline cirrhosis (incident rate ratio, 2.86 [95% CI, 1.33-6.16]; P=0.007), pulmonary disease (incident rate ratio, 1.70 [95% CI, 1.16-2.48]; P=0.006), and renal insufficiency (incident rate ratio, 1.71 [95% CI, 1.03-2.83]; P=0.04). Timing of PVE was similar between TAVR and SAVR (<30 days: 4.2% vs 8.3%; 31 days to 1 year: 52.6% vs 66.7%; >1 year: 43.2% vs 25.0%; P=0.28). Staphylococcus occurred more commonly after SAVR (58.3% vs 28.4% in TAVR; P=0.04). PVE was strongly associated with all-cause mortality after endocarditis diagnosis (hazard ratio, 4.4 [95% CI, 3.42-5.72]; P<0.0001). CONCLUSIONS: The widespread adoption of TAVR and application to lower-risk patients makes understanding mechanisms of valve failure increasingly important. PVE is an established mechanism of prosthetic valve failure post-SAVR and TAVR with unclear differences between approaches. We herein demonstrate in the largest trials and registries of TAVR that PVE remains rare, but often fatal, in modern AVR experience and that there is no difference in incidence, predictors, or risk of PVE between TAVR and SAVR. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov. Unique identifiers: NCT00530894 (PARTNER 1), NCT01314313 (PARTNER 1IA), NCT02184442 (PARTNER 1IB), NCT03222141 (PII S3HR), NCT03222128 (PII S3i).

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 10, 2019

Volume

140

Issue

24

Start / End Page

1984 / 1994

Location

United States

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Severity of Illness Index
  • Risk Factors
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Female
  • Endocarditis
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Summers, M. R., Leon, M. B., Smith, C. R., Kodali, S. K., Thourani, V. H., Herrmann, H. C., … Jaber, W. A. (2019). Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials. Circulation, 140(24), 1984–1994. https://doi.org/10.1161/CIRCULATIONAHA.119.041399
Summers, Matthew R., Martin B. Leon, Craig R. Smith, Susheel K. Kodali, Vinod H. Thourani, Howard C. Herrmann, Raj R. Makkar, et al. “Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials.Circulation 140, no. 24 (December 10, 2019): 1984–94. https://doi.org/10.1161/CIRCULATIONAHA.119.041399.
Summers MR, Leon MB, Smith CR, Kodali SK, Thourani VH, Herrmann HC, et al. Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials. Circulation. 2019 Dec 10;140(24):1984–94.
Summers, Matthew R., et al. “Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials.Circulation, vol. 140, no. 24, Dec. 2019, pp. 1984–94. Pubmed, doi:10.1161/CIRCULATIONAHA.119.041399.
Summers MR, Leon MB, Smith CR, Kodali SK, Thourani VH, Herrmann HC, Makkar RR, Pibarot P, Webb JG, Leipsic J, Alu MC, Crowley A, Hahn RT, Kapadia SR, Tuzcu EM, Svensson L, Cremer PC, Jaber WA. Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials. Circulation. 2019 Dec 10;140(24):1984–1994.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

December 10, 2019

Volume

140

Issue

24

Start / End Page

1984 / 1994

Location

United States

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Severity of Illness Index
  • Risk Factors
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Female
  • Endocarditis
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis