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Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement

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@article{9ad8e9adb9b24720b5be1352a784b8a9,
title = "Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement",
abstract = "BACKGROUND: Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.OBJECTIVES: This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.METHODS: In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.RESULTS: A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4{\%}) with TAVR and 186 patients (4.9{\%}) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95{\%} confidence interval [CI]: 1.4 to 1.9) and 1.2 (95{\%} CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3{\%} (95{\%} CI: 1.8{\%} to 2.9{\%}) and 1.8{\%} (95{\%} CI: 1.4{\%} to 2.3{\%}) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8{\%} (95{\%} CI: 4.7{\%} to 7.0{\%}) and 5.1{\%} (95{\%} CI: 4.4{\%} to 6.0{\%}), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95{\%} CI: 0.84 to 1.49).CONCLUSIONS: The 5-year incidence of IE following TAVR was 5.8{\%} and not significantly different than the incidence following SAVR.",
author = "Butt, {Jawad H} and Nikolaj Ihlemann and {De Backer}, Ole and Lars S{\o}ndergaard and Eva Havers-Borgersen and Gislason, {Gunnar H} and Christian Torp-Pedersen and Lars K{\o}ber and Fosb{\o}l, {Emil L}",
note = "Copyright {\circledC} 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "4",
day = "9",
doi = "10.1016/j.jacc.2018.12.078",
language = "English",
volume = "73",
pages = "1646--1655",
journal = "American College of Cardiology. Journal",
issn = "0735-1097",
publisher = "Elsevier Inc",
number = "13",

}

RIS

TY - JOUR

T1 - Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement

AU - Butt, Jawad H

AU - Ihlemann, Nikolaj

AU - De Backer, Ole

AU - Søndergaard, Lars

AU - Havers-Borgersen, Eva

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Fosbøl, Emil L

N1 - Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2019/4/9

Y1 - 2019/4/9

N2 - BACKGROUND: Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.OBJECTIVES: This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.METHODS: In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.RESULTS: A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).CONCLUSIONS: The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.

AB - BACKGROUND: Patients undergoing surgical aortic valve replacement (SAVR) are considered at high risk of infective endocarditis (IE). However, data on the risk of IE following transcatheter aortic valve replacement (TAVR) are sparse and limited by the lack of long-term follow-up as well as a direct comparison with patients undergoing SAVR.OBJECTIVES: This study sought to investigate the long-term incidence of IE in patients undergoing TAVR and to compare the long-term risk of IE with patients undergoing isolated SAVR.METHODS: In this nationwide observational cohort study, all patients undergoing TAVR and isolated SAVR from January 1, 2008, to December 31, 2016, with no history of IE and alive at discharge were identified using data from Danish nationwide registries.RESULTS: A total of 2,632 patients undergoing TAVR and 3,777 patients undergoing isolated SAVR were identified. During a mean follow-up of 3.6 years, 115 patients (4.4%) with TAVR and 186 patients (4.9%) with SAVR were admitted with IE. The median time from procedure to IE hospitalization was 352 days (25th to 75th percentile: 133 to 778 days) in the TAVR group and 625 days (25th to 75th percentile: 209 to 1,385 days) in the SAVR group. The crude incidence rates of IE were 1.6 (95% confidence interval [CI]: 1.4 to 1.9) and 1.2 (95% CI: 1.0 to 1.4) events per 100 person-years in TAVR and SAVR patients, respectively. The cumulative 1-year risk of IE was 2.3% (95% CI: 1.8% to 2.9%) and 1.8% (95% CI: 1.4% to 2.3%) in TAVR and SAVR patients, respectively. Correspondingly, the cumulative 5-year risk of IE was 5.8% (95% CI: 4.7% to 7.0%) and 5.1% (95% CI: 4.4% to 6.0%), respectively. In multivariable Cox proportional hazard analysis, TAVR was not associated with a statistically significant different risk of IE compared with SAVR (hazard ratio: 1.12; 95% CI: 0.84 to 1.49).CONCLUSIONS: The 5-year incidence of IE following TAVR was 5.8% and not significantly different than the incidence following SAVR.

U2 - 10.1016/j.jacc.2018.12.078

DO - 10.1016/j.jacc.2018.12.078

M3 - Journal article

VL - 73

SP - 1646

EP - 1655

JO - American College of Cardiology. Journal

JF - American College of Cardiology. Journal

SN - 0735-1097

IS - 13

ER -

ID: 56962806