<p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Infective endocarditis does not bode well for patients after transcatheter aortic valve replacement (TAVR), according to a single-center study.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Infective endocarditis was recorded in 3.02% of patients over a median of about 1 year after the procedure, for a rate of 1.82% per patient-year,<span class="apple-converted-space"> </span><a href="http://www.leipzig-kardiologie.de/mit/mang/mang_kon.php" target="_blank">Norman Mangner, MD</a>, of Germany’s University of Leipzig — Heart Center Leipzig, and colleagues reported online in the<span class="apple-converted-space"> </span><em>Journal of the American College of Cardiology</em>.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Of those diagnosed with the infection, 63.6% died in the hospital after a median of 28 days and 74.5% had died by 1 year.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Mortality was tied to chronic hemodialysis (HR 8.60, 95% CI 2.15-34.44), heart failure (HR 2.77, 95% CI 1.20-6.39), and sepsis or septic shock (HR 5.50, 95% CI 2.18-13.85).</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">“Infective endocarditis-related complications such as heart failure and sepsis predicted in-hospital death, suggesting an early and aggressive therapy approach (e.g., surgery) may<span class="apple-converted-space"> </span><a href="http://www.medpagetoday.com/cardiology/pci/33517" target="_blank">improve outcome</a>,” the researchers wrote. “Patients requiring chronic hemodialysis remain the highest risk group for both development of and death by infective endocarditis after<span class="apple-converted-space"> </span><a href="http://www.medpagetoday.com/cardiology/pci/55795" target="_blank">transfemoral TAVR</a>.”</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Independent predictors for developing<span class="apple-converted-space"> </span><a href="http://www.medpagetoday.com/meetingcoverage/aha/48741" target="_blank">infective endocarditis</a><span class="apple-converted-space"> </span>were chronic hemodialysis (hazard ratio 8.37, 95% CI 2.54-27.63) and peripheral artery disease (HR 3.77, 95% CI 1.88-7.58).</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">The source of the bacteria was possibly identified in 77.3% of patients, with 41.8% of cases described as hospital-acquired<span class="apple-converted-space"> </span><a href="http://www.medpagetoday.com/AHAVideoOnTheScene2014/Cardiology/AHA-Videos/890" target="_blank">infective endocarditis</a>. The most common culprit bacteria were coagulase-positive<span class="apple-converted-space"> </span><em>staphylococci</em><span class="apple-converted-space"> </span>(38.2% of cases) and<span class="apple-converted-space"> </span><em>enterococci</em>.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">“This highlights the need for preventive and aseptic techniques during health care procedures in these high-risk patients,” the authors suggested.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Most patients (83.6%) were given antibiotics as the sole treatment. Only 16.4% underwent surgery, even though about two-thirds (64.8%) had at least one indication for an invasive procedure, such as heart failure (37%), sepsis or septic shock (40.7%), or systemic embolism (21.8%).</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">“Treatment of infective endocarditis was a conservative approach in most patients, with a minority also undergoing surgery despite a high rate of potential indications for surgery,” Mangner’s group noted.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Mangner’s investigation included records of 1,820 patients who got TAVR with a transfemoral approach at a single center.</span></p> <p style="margin: 0in 0in 6.0pt 0in;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif'; color: black;">Infective endocarditis was diagnosed in 74.5% within 12 months of TAVR, with the remaining 25.5% of cases emerging later at a median of 628 days.</span></p>