Abstract
Objectives
Despite increased use of transcatheter aortic valve implantation (TAVI) in older adults with severe aortic stenosis, contemporary data on infective endocarditis (IE)—an infrequent but serious complication—are lacking. This study addresses this gap in knowledge.
Methods
We analysed 280 073 Medicare beneficiaries who underwent TAVI between 2013 and 2022. The primary outcome was the change in the 1-year incidence rate of IE post-TAVI. Joinpoint regression was used to evaluate the trend in the IE incidence as annual percent change (APC). Adjusted Cox models were used to evaluate associations between IE incidence and patient characteristics, as well as 12-month outcomes.
Results
The incidence rate of IE 1 year post-TAVI decreased from 20.0/1000 person-years in 2013 to 13.1/1000 in 2021. There was no change in incidence between 2013 and 2018 but a significant decline thereafter (−12.1% [CI, −20.7% to −7.5%], P < .001). This decline was associated with the decrease in non-elective TAVI (sub-distribution hazard ratio: 0.98 [CI, 0.94-0.99], P < .001); 4.8% of patients with IE underwent aortic valve reintervention. The 30-day aortic valve reintervention rate after IE increased significantly from 2013 to 2022 (APC: 24.9% [CI, 17.2%-33.0%], P < .001). The 30-day mortality rate after TAVI explant was 9.3%; the adjusted risk of death declined over time (HR: 0.73 [CI, 0.58-0.92], P = .01). However, the overall 30-day risk-adjusted mortality rate of TAVI-IE remained unchanged.
Conclusions
The post-TAVI incidence of IE in Medicare patients decreased after 2019. This decrease was associated with declining rates of non-elective TAVI and coincided with FDA approval of TAVI for low-risk patients. TAVI explant rates were low but increased recently. The lack of improvement in 30-day mortality underscores the challenges of elderly care after TAVI.
Keywords: TAVI, endocarditis, transcatheter, aortic valve, trend
Prosthetic valve endocarditis, an infrequent but life-threatening complication following heart valve replacement, accounts for about 20% of all cases of infective endocarditis (IE) and carries an excess hazard of death and major complications compared to native valve IE.
Graphical abstract
INTRODUCTION
Prosthetic valve endocarditis, an infrequent but life-threatening complication following heart valve replacement, accounts for about 20% of all cases of infective endocarditis (IE) and carries an excess hazard of death and major complications compared to native valve IE.1,2 The development of IE after transcatheter aortic valve implantation (TAVI), a procedure undertaken with increasing frequency in older adults with severe aortic stenosis (AS), highlights the adverse outcomes that can befall patients who may also have a high burden of medical co-morbidities. TAVI was initially FDA-approved as an alternative to surgical aortic valve replacement (SAVR) for high surgical-risk patients (2012) and then underwent expansion to lower surgical-risk patients (intermediate risk in 2016 and low risk in 2019).3
Observational studies, the majority of which are relatively small and reported in the era before the 2019 FDA approval in low-risk patients, have reported a range of post-TAVI IE incidence rates from 0.3% to 5.5%.2,4–6 Whereas the landmark randomized trials,7,8 which were the basis for FDA approval, reported IE incidence rates in intermediate- and low-risk patients that ranged between 0.7% and 3.0% per person-year. These estimates are based on select populations and a few events, underscoring the lack of robust, contemporary data on IE incidence and outcomes in routine TAVI practice. Moreover, there is little insight into how the changing surgical-risk profile of TAVI patients over time may be associated with clinical outcomes.9 In the current study, we examine the trends in the incidence of and outcomes following the development of IE among Medicare TAVI patients from 2013 to 2022.
PATIENTS AND METHODS
Data source and patient selection
Medicare is a federal insurance programme for Americans aged 65 or older. Medicare Inpatient Standard Analytical and Denominator files, including the years 2013-2022, were used to define the study population. They contain information on diagnoses, procedures, demographics, payments, patient identifiers, and provider identifiers. Medicare beneficiaries were included in the study if they were at least 65 years old and underwent TAVI as defined by the International Classification Diagnosis codes version 9 (ICD-9) and version 10 (ICD-10) (Table S1). There were 254 TAVI procedures converted to SAVR that were not included in the analysis. Exclusion criteria included a history of IE, heart transplant, or left ventricular assisted device, prior aortic valve surgery, prior thoracic aortic surgery, or concomitant cardiac valve procedures at the time of TAVI (see Figure S1, exclusion flow chart). At least 1 year of records before TAVI was used to define patients’ history in addition to secondary present-on-admission ICD codes during index hospitalization.
Study end-points
The primary outcome is the change in the incidence rate of early IE (defined as IE within 1 year after TAVI procedures) between 2013 and 2022, calculated as the number of events per 1000 person-years. Secondary outcomes include the 30-day and 6-month incidence of post-TAVI IE, the cumulative incidence of reintervention, mortality rates (30 days, 6 months, and 1 year) after IE, and trends in 30-day TAVI explant rates and related mortality. Reintervention after TAVI was defined as SAVR after TAVI explant. Risk factors associated with the development of IE, 30-day mortality, and reintervention after TAVI-IE are analysed.
Statistical analysis
Baseline demographics and comorbidities for patients undergoing TAVI stratified by IE status were reported as means with standard deviations or medians with interquartile ranges for continuous variables, depending on their distribution. Frequencies with percentages are reported for categorical variables. Continuous variables were analysed using Mood’s median test for 2-group comparison and Kruskal–Wallis test for 3-group comparison; categorical variables were compared using the Chi2 or Fisher’s exact test as appropriate.
The incidence rate of 1-year IE per 1000 person-years was calculated for each year, and the annual percent change (APC) in the incidence between 2013 and 2021 was estimated using segmented (Joinpoint) regression. This statistical method identifies years in which a significant change in the linear trend occurred. For model specifications, we used the grid search method for joinpoint determination (0-7 joinpoints), the permutation test for model selection, and parametric CI estimation.
The adjusted Cox proportional hazard model was used to assess the risk factors associated with IE post-TAVI within 1 year, controlling for patient characteristics (including age, race, sex, comorbidities, admission type, and year of TAVI) while accounting for in-hospital clustering. The cohort included all TAVI patients, and death was used as a competing risk event. The results were reported as sub-distribution hazard ratios (sHRs) with a 95% CI. Follow-up was 1 year post-TAVI, with censoring if no event occurred.
To assess the incidence of reintervention (explant) and death after TAVI-IE, all IE patients were included in the analysis and were followed up to 1 year after IE diagnosis. Risk-adjusted estimates of reintervention and mortality rates were generated using predictive margins. Generalized Estimating Equations model-based predictions were used to estimate the marginal effect and generate adjusted estimates. The CIs were estimated using the Delta method. The variables used for adjustment included age, sex, race, major comorbidities, sepsis at admission, time from index TAVI to IE, and year of TAVI.
The cumulative incidence of death was reported at 30 days, 6 months, and 1 year post-IE using the Kaplan–Meier estimator. The cumulative incidence of reintervention post-IE was calculated using the cumulative incidence function with death as a competing risk event. A Cox proportional hazard model, with reintervention as a time-varying covariate, was used to assess the association between mortality and surgical explant post-IE. The proportional hazard assumption was checked by plotting Schoenfeld residuals. The cutoff value for statistical significance was set as 0.05. Less than 1% of records had missing admission status and were excluded from the regression analysis.
This study was approved by the Mount Sinai Institutional Review Board (study 15-00807-CR005, July 17, 2024). All statistical analyses used the Statistical Analysis System, version 9.4 (SAS Institute Inc., Cary, NC). The trend analysis was done using Joinpoint Trend Analysis Software version 5.0 (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute).10
RESULTS
Patient characteristics
Between 2013 and 2022, 280 073 Medicare beneficiaries underwent TAVI, with more than 70% of patients having AS as the indication for treatment (Table S2). A total of 8144 (2.9%) patients developed IE. Within 30 days, only 0.2% of TAVI patients (7.2% of IE cases) developed IE, a rate that increased to 0.9% by 6 months and 1.4% within 1 year of the TAVI. Compared with patients without IE, patients with IE were younger (median age 80 vs 81, P < .001) and more often male (60.8% vs 55%, P < .001, Table S3). The prevalence of major co-morbidities, including diabetes, chronic kidney disease, and the use of dialysis, was also higher among IE patients. Emergent or urgent TAVI was more common in patients with IE (22.8% vs 14.7%, P < .001). Table S3 depicts trends in the patient characteristics stratified by the time of FDA approval of TAVI for high-, intermediate-, and low-surgical-risk patients. Patients who experienced IE in 2020-2022 were younger and had lower rates of coronary revascularization, chronic obstructive pulmonary disease, and permanent pacemakers than patients in 2013-2019. The median frailty score declined consistently from 29.7% in 2013-2016 to 25.4% in 2016-2019 to 12% in 2019-2022.
The incidence of IE over time and risk factors
The trend in 30-day post-TAVI IE incidence did not change over time (APC = −6.3% [−13.3 to 1.1%], P = .10); however, the rate at 6 months declined significantly (APC = −5.7% [−9.7% to −1.8%], P = 0.01), Figure 1A. As illustrated in Figure 1B, the incidence rate of IE at 1 year post-TAVI decreased from 20.0/1000 person-years in 2013 to 13.1/1000 person-years in 2021 (APC = −0.05% [95% CI, −4.1% to 0.0%], P = .01). There was no change in early IE incidence per 1000 person-years between 2013 and 2018 (APC = −0.9% [95% CI, −3.3% to 4.1%], P = .59), followed by a significant decline thereafter (−12.1% [95% CI, −20.7% to −7.5%], P < .001).
Figure 1.
The Change in (A) 30-Day and 6-Month Post-TAVI IE Rates and (B) 1-Year Post-TAVI IE Incidence Rate Per 1000 Person-Years Among Medicare Patients Receiving TAVI from 2013 Through 2022
In multivariable analysis, the risk of early IE declined over time (Figure 2). Increasing age was associated with a lower risk for IE (sHR: 0.98 [95% CI, 0.97-0.99], P < .001). Risk factors for IE included male sex and several major comorbidities, such as dialysis, atrial fibrillation, heart failure, and liver disease. The declining rates of non-elective TAVI procedures were associated with declining risk-adjusted IE incidence over time (sHR: 0.97 [95% CI, 0.94-0.99], P < .001). There was no association between early IE incidence and the use of transapical access or underlying morphology bicuspid valve disease (Figure S2).
Figure 2.
Risk Factors Associated With Early IE After TAVI in Medicare Patients
Mortality
A total of 1541 patients (18.9%) died either during their index hospitalization or within 30 days of IE diagnosis. As seen in Figure S2A, the mortality rate rose sharply within the first 30 days after IE diagnosis to 19% [95% CI, 18.1%-19.8%]. After risk adjustment, the mortality rate was 17.6% [16.8%-18.5%] at 30 days, 35.6% [34.5%-36.6%] at 6 months, and 42.3% [41.2%-43.3%] at 1 year post-IE.
There was no change in the observed 30-day mortality after IE between 2013 and 2022 (APC: 0.6% [95% CI, −1.4% to 2.6%], P = .41) (Figure 3A). Similarly, risk-adjusted 30-day mortality after IE did not change over time (Figure 4A). Sepsis/bacteraemia on admission, dialysis, and COPD were associated with higher mortality at 30 days post-IE.
Figure 3.
Thirty-Day Mortality (A) and Reintervention (B) Rates After IE in Medicare TAVI Patients From 2013 Through 2022
Figure 4.
Risk Factors Associated with Mortality (A) and Reintervention (B) After Post-TAVI IE.
Reintervention rates
Among patients experiencing IE, 387 (4.8%) underwent surgical explant. The median time to aortic valve reintervention after IE was 17 [IQR: 8-106] days. Among patients who underwent reintervention, 65% had their explant within the first 30 days post-IE (3.1% of the IE population). The cumulative incidence of reintervention at 6-month and 1-year follow-up was 4.5% [4.0%-5.0%] and 5.2% [4.6%-5.7%], respectively (Figure S2B). Patients who underwent reintervention for IE were younger (median age: 74 vs 80, P < .001), were more likely to be male (69.5% vs 60.4%, P < .001), and had higher rates of comorbid conditions, as shown in Table 1.
Table 1.
Comparison of Baseline Characteristics of Medicare Patients With Post-TAVI Infective Endocarditis (IE) Who Underwent Surgical Reintervention and Those Who Did Not Undergo Reintervention
| Patients with IE post-TAVI |
|||
|---|---|---|---|
| Without reintervention (N = 7757) | Underwent reintervention (N = 387) | P | |
| Procedural variables | |||
| Age (median [IQR]) | 80 [74-85] | 74 [70-78] | <0.001 |
| Age group | <0.001 | ||
| 65-70 years | 997 (12.9) | 117 (30.2) | |
| 71-75 years | 1338 (17.2) | 119 (30.7) | |
| 76-80 years | 1689 (21.8) | 91 (23.5) | |
| 81-85 years | 1910 (24.6) | 49 (12.7) | |
| >85 years | 1823 (23.5) | 11 (2.8) | |
| Race | 0.64 | ||
| White | 7230 (93.2) | 357 (92.2) | |
| Black | 256 (3.3) | 12 (3.1) | |
| Hispanic | 64 (0.8) | <10 | |
| Other | 207 (2.7) | 13 (3.4) | |
| Sex | <0.001 | ||
| Male | 4686 (60.4) | 269 (69.5) | |
| Female | 3071 (39.6) | 118 (30.5) | |
| Type of admission a | <0.001 | ||
| Emergent | 949 (12.2) | 22 (5.7) | |
| Urgent | 853 (11.0) | 32 (8.3) | |
| Elective | 5933 (76.5) | 332 (85.8) | |
| Access site | 0.77 | ||
| Transapical | 303 (3.9) | 14 (3.6) | |
| Transfemoral/other sitesb | 7454 (96.1) | 373 (96.4) | |
| Pre-procedural variables | |||
| Comorbidities | |||
| Hypertension | 7579 (97.7) | 367 (94.8) | <0.001 |
| Congestive heart failure | 6498 (83.8) | 297 (76.7) | <0.001 |
| Bicuspid aortic valve | 131 (1.7) | 13 (3.4) | 0.02 |
| CAD unrevascularized | 7086 (91.3) | 325 (84.0) | 0.16 |
| CAD with PCI | 1920 (24.8) | 68 (17.6) | 0.002 |
| CAD with CABG | 1875 (24.2) | 73 (18.9) | 0.03 |
| CVD | 3418 (44.1) | 136 (35.1) | <0.001 |
| Stroke | 697 (9.0) | 19 (4.9) | 0.01 |
| PVD | 4213 (54.3) | 189 (48.8) | 0.03 |
| Coagulopathy | 1695 (21.9) | 66 (17.1) | 0.03 |
| Atrial fibrillation | 3973 (51.2) | 148 (38.2) | <0.001 |
| History of permanent pacemaker | 1445 (18.6) | 33 (8.5) | <0.001 |
| Diabetes mellitus | 3930 (50.7) | 184 (47.5) | 0.23 |
| COPD | 3110 (40.1) | 116 (30.0) | <0.001 |
| CKD without dialysis | 3483 (44.9) | 124 (32.0) | <0.001 |
| CKD with dialysis | 607 (7.8) | 17 (4.4) | 0.01 |
| Liver disease | 1477 (19.0) | 75 (19.4) | 0.87 |
| Immunocompromised | 5945 (76.6) | 259 (66.9) | <0.001 |
| Drug/substance abuse | 179 (2.3) | <10 | 0.10 |
| Alcohol use | 262 (3.4) | 10 (2.6) | 0.40 |
The admission types do not sum up to 100% due to the presence of missing data.
Other sites include: transaortic and transsubclavian.
There was an increase in observed 30-day reintervention rates between 2013 and 2022 (APC: 24.9% [17.2%-33.0%], P < .001) (Figure 3B). After risk adjustment, the 30-day surgical explant rate after IE only became significantly higher in 2021, albeit with wide CIs (Figure 4B). Older age was associated with a lower likelihood of TAVI explant at 30 days. The likelihood of reintervention decreased by 39% with each 5-year increase in age (sHR: 0.61 [95% CI, 0.54-0.67], P < .001). Patients with comorbidities such as chronic kidney disease requiring dialysis and implanted permanent pacemakers were less likely to undergo reintervention. Men and patients experiencing sepsis/bacteraemia were more likely to undergo reintervention. Stratified analysis was performed to differentiate the role of biological age and frailty in the occurrence of IE and reintervention after IE. Table S4 shows that patients with IE had higher frailty scores across all age groups. However, the scores of those who underwent reintervention were lower, suggesting they may have been better candidates for surgery.
Out of 387 patients who underwent reintervention for IE, 36 died within 30 days (9.3%), and 81 died within 1 year (20.9%). The 30-day adjusted risk of mortality after TAVI explant has declined over time (HR: 0.73 [95% CI, 0.58-0.92], P = .01), with a risk-adjusted hazard ratio for 1-year mortality of 0.88 (95% CI, 0.77-1.00, P = .05).
DISCUSSION
Our study in Medicare patients showed a significant decrease in the 1-year incidence rate of IE after TAVI from 20.0/1000 person-years in 2013 to 13.1/1000 in 2021. The major decline in the IE incidence rate between 2019 and 2022 was associated with a decrease in the rates of non-elective TAVI procedures. The risk factors of IE included male sex and major comorbidities, such as renal failure with dialysis, heart failure, pacemaker implantation, and liver disease. In recent years, the reintervention rate following IE diagnosis increased, and the 30-day adjusted mortality rates after TAVI explant declined. By comparison, the overall 30-day risk-adjusted mortality rate of TAVI-IE was high and did not change over time.
In our study, the incidence rate of IE was 11.7/1000 person-years, aligning with prior reports. Prior studies reported a range from 3 to 20/1000 person-years.3,11–15 Our study revealed a reduction in the 1-year incidence rate that became evident only after 2019. To put this in context, Mentias et al.15 found a decrease in early and late incidence of post-TAVI IE among Medicare patients in an earlier time (2012-2017). Our findings are consistent with the trends from an international registry-based study in 552 patients with IE by Del Val et al.,16 who reported no difference in the overall incidence rate of IE in patients receiving TAVI between 2005 and 2013 compared to those receiving TAVI between 2014 and 2020. The decline in the incidence rates of 1-year IE might be attributable to the changing patient risk profile (approval in low-risk patients), reduction in the proportion of emergent and urgent TAVI procedures, as well as enhanced periprocedural management (eg, optimized infection control measures), and shifts to transfemoral access and smaller delivery systems. Reduced non-elective TAVI may also be associated with unmeasured confounders, such as acuity and procedural contamination risk, influencing admission type and IE incidence.
A systematic review of 33 studies identified younger age and male sex as non-modifiable risk factors for IE after TAVI.17 In our study, the age difference (1 year) was not clinically meaningful. Furthermore, this finding would be inconsistent with literature estimates of the incidence of native valve IE, which increases with older age.18,19 There is a need for consideration of modifiable IE risk factors among younger TAVI patients, including substance abuse, immunocompromised status, dialysis, and liver disease.19,20
In our study, the in-hospital TAVI valve explant rate was 1.8%, similar to the 2% reported in the Swedish TAVI registry.12 A systematic review including 12 observational studies and 5 randomized clinical trials reported TAVI explant rates to vary substantially, with rates ranging between 0% and 20%. Although favourable outcomes were reported after early surgical treatment of transcatheter IE,21 only a small percentage of patients with an indication for surgery underwent explant due to their age and high burden of comorbidities. The explant rate has been increasing over recent years, probably related to younger ages and more favourable risk profiles of TAVI patients.
An analysis of Medicare patients experiencing post-TAVI IE before 2017 reported mortality rates similar to our study (18.5% at 30 days and 45.6% at 1 year).15 According to a review by Del Val et al.,3 among 10 studies that reported mortality 1 year after TAVI-IE, 6 reported a mortality rate between 40% and 47%. The SWISSTAVI cohort study demonstrated that the highest incidence of death was within the first 30 days of IE diagnosis, the same pattern observed in our study.22 Sepsis on admission, heart failure, and haemodialysis were independently associated with mortality after TAVI, the same variables identified in the previous analyses.23,24
Given the high mortality and challenging management of post-TAVI IE, efforts focused on prevention are critical. A multicentre study showed that microorganisms resistant to the default periprocedural antibiotic regimen were responsible for early IE after TAVI in many cases.22 As a result, some investigators have recommended amoxicillin/clavulanic acid for prophylaxis or adding a glycopeptide to the existing regimen to cover methicillin-resistant staphylococci.25 A randomized trial of agents for prophylaxis might be informative.
Our observational study offers a national perspective with coded IE incidence data, mortality, and reintervention data on nearly 300 000 patients post-TAVI; nevertheless, it has some limitations. We used an administrative database without information about clinical variables, such as STS risk score, type of TAVI device, and microbiological and pathogen findings. Future studies may benefit from linkage with other sources of healthcare-related infection databases, such as the Healthcare-Associated Infection measures—provider data. We also lack information about the periprocedural antibiotic protocol that may have contributed to postoperative IE. We relied on ICD codes, which are prone to misclassification and coding errors, to identify TAVI procedures, and IE cases. We also lack clinical or microbiological validation of IE; thus, we could not establish whether patients met the modified Duke criteria for IE diagnosis. However, a study validated the diagnosis of IE based on ICD-9 and ICD-10 codes against a chart review using the modified Duke criteria and found that ICD codes had a positive predictive value of 94% for identifying IE.26 Finally, we define reintervention as surgical explant only without valve-in-valve, which may have contributed to an underestimation of the overall incidence of reintervention.
CONCLUSION
The incidence of IE in Medicare patients within 1 year after TAVI declined between 2013 and 2022, largely related to a decline after 2019. This decrease was associated with declining rates of non-elective TAVI procedures and coincided with the FDA approval of TAVI for low-risk patients. The overall 30-day mortality rates after IE remained high and did not decline. There is a need for further research on best practices to reduce the incidence of post-TAVI IE and improve outcomes, especially in an older patient population with a high burden of medical co-morbidities.
Supplementary Material
ACKNOWLEDGEMENTS
The content of this manuscript is solely the responsibility of the authors and does not necessarily reflect the official views of the National Heart, Lung, and Blood Institute, National Institutes of Health, or the United States Department of Health and Human Services.
Contributor Information
Sundos H Alabbadi, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
Alexander Iribarne, Department of Cardiothoracic Surgery, Staten Island University Hospital/Northwell Health, Staten Island, NY, 10305, United States.
Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, G1V 4G5, Canada; Clínic Barcelona, Barcelona, Barcelona, 08036, Spain.
Torsten Doenst, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, 07747, Germany.
Joanna Chikwe, Cedars Sinai Medical Center, Los Angeles, California, 90048, United States.
Shinobu Itagaki, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
Nana Toyoda, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
Raj Makkar, Cedars Sinai Medical Center, Los Angeles, California, 90048, United States.
Enoch F Akowuah, Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BW, United Kingdom.
Marissa Perez, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
W Patricia Bandettini, Div. of Cardiovascular Sciences, National Institutes of Health, Bethesda, Maryland, 20892-7940, United States.
Shahab A Akhter, East Carolina University, Greenville, North Carolina, 27834, United States.
Sabine Bleiziffer, HDZ NRW, Bad Oeynhausen, D-32545, Germany.
Markus Krane, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, 80636, Germany.
Hirsh Makhija, University of California San Diego, La Jolla, California, 92093, United States.
Ranjit Deshpande, Guthrie Clinic, King’s College Hospital, NHS Foundation Trust, Denmark Hill, London, SE5 9RS, United Kingdom.
Annetine C Gelijns, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
Natalia N Egorova, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY, 10029, United States.
SUPPLEMENTARY MATERIAL
Supplementary material is available at EJCTS online.
FUNDING
This research was supported by a co-operative agreement (U01 HL088942) funded by the National Heart, Lung, and Blood Institute, the National Institutes of Neurological Disorders and Stroke of the National Institutes of Health, Bethesda, MD, and the Canadian Institutes of Health Research.
CONFLICTS OF INTEREST
All authors have nothing to disclose.
DATA AVAILABILITY
No new data were generated or analysed in support of this research. Under the Data Use Agreement with the US Center of Medicare and Medicaid Services, data cannot be re-released or redistributed in any form.
REFERENCES
- 1. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis: results of a one-year survey in France. JAMA. 2002;288:75-81. [DOI] [PubMed] [Google Scholar]
- 2. Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H, et al. Response to letters regarding article, “infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry”. Circulation. 2015;132:e372-e374. [DOI] [PubMed] [Google Scholar]
- 3.US Food and Drug Administration. FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery. 2019. Accessed February 28, 2023. https://www.fda.gov/news-events/press-announcements/fda-expands-indication-several-transcatheter-heart-valves-patients-low-risk-death-or-major. [Google Scholar]
- 4.Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J. Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2023;81:394-412. [DOI] [PubMed] [Google Scholar]
- 5.Slouha E, Rood C, Burle VS, Al-Geizi H, Clunes LA, Kollias TF. Infective Endocarditis Following Aortic Valve Replacement: A Systematic Review. Cureus. 2023;15:e49048. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Østergaard L, Lauridsen TK, Iversen K, et al. Infective endocarditis in patients who have undergone transcatheter aortic valve implantation: a review. Clin Microbiol Infect. 2020;26:999-1007. [DOI] [PubMed] [Google Scholar]
- 7. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-1607. [DOI] [PubMed] [Google Scholar]
- 8. Smith CR, , LeonMB, , Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187-2198. [DOI] [PubMed] [Google Scholar]
- 9. Fauchier L, , BissonA, , Herbert J, et al. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect. 2020;26:1368-1374. [DOI] [PubMed] [Google Scholar]
- 10. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–351. [DOI] [PubMed] [Google Scholar]
- 11. Ando T, , AshrafS, , Villablanca PA, et al. Meta-analysis comparing the incidence of infective endocarditis following transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol. 2019;123:827-832. [DOI] [PubMed] [Google Scholar]
- 12. Bjursten H, Rasmussen M, Nozohoor S, et al. Infective endocarditis after transcatheter aortic valve implantation: a nationwide study. Eur Heart J. 2019;40:3263-3269. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Kolte D, Goldsweig A, Kennedy KF, et al. Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States. Am J Cardiol. 2018;122:2112-2119. [DOI] [PubMed] [Google Scholar]
- 14. Yeo I, Kim LK, Park SO, Wong SC. In-hospital infective endocarditis following transcatheter aortic valve replacement: a cross-sectional study of the national inpatient sample database in the USA. J Hosp Infect. 2018;100:444-450. [DOI] [PubMed] [Google Scholar]
- 15. Mentias A, Girotra S, Desai MY, et al. Incidence, predictors, and outcomes of endocarditis after transcatheter aortic valve replacement in the United States. JACC Cardiovasc Interv. 2020;13:1973-1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Del Val D, Abdel-Wahab M, Linke A, et al. Temporal trends, characteristics, and outcomes of infective endocarditis after transcatheter aortic valve replacement. Clin Infect Dis. 2021;73:e3750-e3758. [DOI] [PubMed] [Google Scholar]
- 17. Sl A, Malik AH, George I, et al. Infective endocarditis after surgical and transcatheter aortic valve replacement: a state of the art review. J Am Heart Assoc. 2020;9:e017347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Ambrosioni J, Hernandez-Meneses M, Téllez A, et al. ; Hospital Clinic Infective Endocarditis Investigators. The changing epidemiology of infective endocarditis in the twenty-first century. Curr Infect Dis Rep. 2017;19:21. [DOI] [PubMed] [Google Scholar]
- 19. Vincent LL, Otto CM. Infective endocarditis: update on epidemiology, outcomes, and management. Curr Cardiol Rep. 2018;20:86. [DOI] [PubMed] [Google Scholar]
- 20. Regueiro A, Linke A, Latib A, et al. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA. 2016;316:1083-1092. [DOI] [PubMed] [Google Scholar]
- 21. Saha S, Joskowiak D, Marin-Cuartas M, et al. Surgery for infective endocarditis following low-intermediate risk transcatheter aortic valve replacement—a multicentre experience. Eur J Cardiothorac Surg. 2022;62:ezac075. [DOI] [PubMed] [Google Scholar]
- 22. Stortecky S, Heg D, Tueller D, et al. Infective endocarditis after transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;75:3020-3030. [DOI] [PubMed] [Google Scholar]
- 23. Mangner N, Woitek F, Haussig S, et al. Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement. J Am Coll Cardiol. 2016;67:2907-2908. [DOI] [PubMed] [Google Scholar]
- 24. Patrat-Delon S, Rouxel A, Gacouin A, et al. EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis. Eur J Cardiothorac Surg. 2016;49:944-951. [DOI] [PubMed] [Google Scholar]
- 25. Conen A, Stortecky S, Moreillon P, et al. A review of recommendations for infective endocarditis prevention in patients undergoing transcatheter aortic valve implantation. EuroIntervention. 2021;16:1135-1140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Toyoda N, Chikwe J, Itagaki S, Gelijns AC, Adams DH, Egorova NN. Trends in infective endocarditis in California and New York state, 1998-2013. JAMA. 2017;317:1652-1660. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
No new data were generated or analysed in support of this research. Under the Data Use Agreement with the US Center of Medicare and Medicaid Services, data cannot be re-released or redistributed in any form.