Comparison of Incidence, Predictors, and Outcomes of Early Infective Endocarditis after Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in the United States

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Infective endocarditis (IE) of prosthetic or bioprosthetic heart valves is a serious complication associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after transcatheter aortic valve implantation (TAVI) in the United States are limited. We used the 2013 to 2014 Nationwide Readmissions Databases to determine the incidence of early IE after TAVI and surgical aortic valve replacement (SAVR) in the US. Clinical characteristics, independent predictors, and outcomes of patients with IE post-TAVI were examined. In 29,306 TAVI and 66,077 SAVR patients, the incidence rates of early IE were 1.7% (95% confidence interval [CI] 1.5% to 1.9%) and 2.5% (95% CI 2.3% to 2.9%) per person-year, respectively. In a propensity-matched cohort of 15,138 TAVI and 15,030 SAVR patients (weighted), there were no significant differences in the incidence rates of IE (1.7% [95% CI 1.4% to 2.0%] vs 1.9% [95% CI 1.6% to 2.2%] per person-year, log-rank p = 0.29) or in the median (interquartile range) time to IE (91 [48 to 146] vs 92 [61 to 214] days, p = 0.13). Staphylococcus (30.4%), Streptococcus (29.9%), and Enterococcus (20.5%) were the most common causative organisms of IE post-TAVI. Younger age, history of heart failure, need for permanent pacemaker placement, cardiac arrest, major bleeding, and sepsis during the index TAVI hospitalization were independently associated with an increased risk of IE. In-hospital mortality rate during readmission for IE was 15.6%. In conclusion, in a nationally representative cohort of TAVI patients in the US, the incidence rate of early IE was 1.7% per person-year. Age, co-morbid conditions, invasive procedures, and complications during the index hospitalization were associated with incident IE post-TAVI.

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Methods

We used the 2013 to 2014 Nationwide Readmissions Databases (NRD) for this study. The NRD is a publicly available, all-payer database developed by the Agency for Healthcare Research and Quality (AHRQ) for the Healthcare Cost and Utilization Project (HCUP). The NRD is compiled from the HCUP State Inpatient Databases that contains data from all community hospitals except rehabilitation and long-term acute care facilities. The NRD represents approximately 50% of the total US resident population and

Results

Baseline characteristics of patients who underwent TAVI or SAVR before and after propensity matching are shown in Table 1. Propensity matching yielded a cohort of 6,942 TAVI and 6,942 SAVR patients (equivalent to a weighted national estimate of 15,138 and 15,030 patients in each group, respectively) who were well balanced on demographics, co-morbidities, and hospital characteristics (standardized difference <10% for all) (Supplementary Figure 1).

In the unmatched cohort, median (IQR) follow-up

Discussion

PVE, although uncommon, is a serious complication associated with significant morbidity and mortality.14 To our knowledge, ours is the largest study to date describing the incidence, predictors, and outcomes of early IE in patients undergoing TAVI and the first large-scale study in the United States. We found that the incidence rate of early IE after TAVI was 1.7% per person-year, and that IE occurred on average 2 months following TAVI. The IE incidence rates and median time to IE were similar

Disclosures

The authors have no conflicts of interest to disclose.

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