Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement
Background Infective endocarditis (IE) after transcatheter aortic valve replacement is a devastating complication associated with a high mortality. Our objective was to determine the impact of cardiac surgery (CS) and antibiotics (IE‐CS) compared with medical treatment with antibiotics only (IE‐ABx)...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010027 |
| _version_ | 1819178392475402240 |
|---|---|
| author | Norman Mangner Sergey Leontyev Felix J. Woitek Philipp Kiefer Stephan Haussig Christian Binner Meinhard Mende Florian Schlotter Georg Stachel Robert Höllriegel Jennifer Hommel Katrin Binner‐Oussenek Martin Misfeld Holger Thiele Michael A. Borger David Holzhey Axel Linke |
| author_facet | Norman Mangner Sergey Leontyev Felix J. Woitek Philipp Kiefer Stephan Haussig Christian Binner Meinhard Mende Florian Schlotter Georg Stachel Robert Höllriegel Jennifer Hommel Katrin Binner‐Oussenek Martin Misfeld Holger Thiele Michael A. Borger David Holzhey Axel Linke |
| author_sort | Norman Mangner |
| collection | DOAJ |
| description | Background Infective endocarditis (IE) after transcatheter aortic valve replacement is a devastating complication associated with a high mortality. Our objective was to determine the impact of cardiac surgery (CS) and antibiotics (IE‐CS) compared with medical treatment with antibiotics only (IE‐ABx) on 1‐year mortality in patients developing IE after transcatheter aortic valve replacement. Methods and Results Patients developing IE after transcatheter aortic valve replacement were included in this retrospective analysis. All‐cause 1‐year mortality was the primary end point. A total of 20 patients underwent IE‐CS compared with 44 patients treated by IE‐ABx. In this unmatched cohort, patients treated by IE‐ABx were older (P=0.006), had a higher Society of Thoracic Surgeons score (P=0.029), and more often had severe chronic kidney disease (P=0.037). One‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 68.2%; P=0.802). The rate of any complication during treatment was higher in the IE‐CS group (P=0.024). In a matched cohort, baseline characteristics were not significantly different. All‐cause 1‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 75%; P=0.490). A Cox regression analysis revealed any indication for surgery (hazard ratio, 6.20; 95% confidence interval, 1.80–21.41; P=0.004), sepsis on admission (hazard ratio, 4.03; 95% confidence interval, 1.97–8.24; P<0.001), and mitral regurgitation ≥2 (hazard ratio, 2.91; 95% confidence interval, 1.33–6.37) as factors associated with 1‐year mortality. Conclusions In patients developing IE after transcatheter aortic valve replacement, mortality was predicted by the severity of IE and concomitant mitral regurgitation. In this small, and therefore statistically limited, but high‐risk patient cohort, CS provided no significant mortality benefit compared with medical therapy. Individual decision making by a “heart and endocarditis team” is necessary to offer those patients the most reasonable treatment option. |
| first_indexed | 2024-12-22T21:41:49Z |
| format | Article |
| id | doaj.art-2f1a1815872e4c6ba84e730554bd1926 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:41:49Z |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2f1a1815872e4c6ba84e730554bd19262022-12-21T18:11:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171710.1161/JAHA.118.010027Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve ReplacementNorman Mangner0Sergey Leontyev1Felix J. Woitek2Philipp Kiefer3Stephan Haussig4Christian Binner5Meinhard Mende6Florian Schlotter7Georg Stachel8Robert Höllriegel9Jennifer Hommel10Katrin Binner‐Oussenek11Martin Misfeld12Holger Thiele13Michael A. Borger14David Holzhey15Axel Linke16Department of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyInstitute for Medical Informatic, Statistics and Epidemiology University of Leipzig Leipzig GermanyDepartment of Cardiology Heart Center Leipzig University Hospital Leipzig GermanyDepartment of Cardiology Heart Center Leipzig University Hospital Leipzig GermanyDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyDepartment of Internal Medicine I Helios Park‐Klinik Leipzig GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyDepartment of Cardiology Heart Center Leipzig University Hospital Leipzig GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyDepartment of Cardiac Surgery Heart Center Leipzig University of Leipzig Leipzig GermanyDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University Dresden Dresden GermanyBackground Infective endocarditis (IE) after transcatheter aortic valve replacement is a devastating complication associated with a high mortality. Our objective was to determine the impact of cardiac surgery (CS) and antibiotics (IE‐CS) compared with medical treatment with antibiotics only (IE‐ABx) on 1‐year mortality in patients developing IE after transcatheter aortic valve replacement. Methods and Results Patients developing IE after transcatheter aortic valve replacement were included in this retrospective analysis. All‐cause 1‐year mortality was the primary end point. A total of 20 patients underwent IE‐CS compared with 44 patients treated by IE‐ABx. In this unmatched cohort, patients treated by IE‐ABx were older (P=0.006), had a higher Society of Thoracic Surgeons score (P=0.029), and more often had severe chronic kidney disease (P=0.037). One‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 68.2%; P=0.802). The rate of any complication during treatment was higher in the IE‐CS group (P=0.024). In a matched cohort, baseline characteristics were not significantly different. All‐cause 1‐year mortality was not different between groups (IE‐CS versus IE‐ABx, 65% versus 75%; P=0.490). A Cox regression analysis revealed any indication for surgery (hazard ratio, 6.20; 95% confidence interval, 1.80–21.41; P=0.004), sepsis on admission (hazard ratio, 4.03; 95% confidence interval, 1.97–8.24; P<0.001), and mitral regurgitation ≥2 (hazard ratio, 2.91; 95% confidence interval, 1.33–6.37) as factors associated with 1‐year mortality. Conclusions In patients developing IE after transcatheter aortic valve replacement, mortality was predicted by the severity of IE and concomitant mitral regurgitation. In this small, and therefore statistically limited, but high‐risk patient cohort, CS provided no significant mortality benefit compared with medical therapy. Individual decision making by a “heart and endocarditis team” is necessary to offer those patients the most reasonable treatment option.https://www.ahajournals.org/doi/10.1161/JAHA.118.010027antibioticcardiac valvular surgeryinfective endocarditisoutcometranscatheter aortic valve implantation |
| spellingShingle | Norman Mangner Sergey Leontyev Felix J. Woitek Philipp Kiefer Stephan Haussig Christian Binner Meinhard Mende Florian Schlotter Georg Stachel Robert Höllriegel Jennifer Hommel Katrin Binner‐Oussenek Martin Misfeld Holger Thiele Michael A. Borger David Holzhey Axel Linke Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease antibiotic cardiac valvular surgery infective endocarditis outcome transcatheter aortic valve implantation |
| title | Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement |
| title_full | Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement |
| title_fullStr | Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement |
| title_short | Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement |
| title_sort | cardiac surgery compared with antibiotics only in patients developing infective endocarditis after transcatheter aortic valve replacement |
| topic | antibiotic cardiac valvular surgery infective endocarditis outcome transcatheter aortic valve implantation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010027 |
| work_keys_str_mv | AT normanmangner cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT sergeyleontyev cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT felixjwoitek cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT philippkiefer cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT stephanhaussig cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT christianbinner cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT meinhardmende cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT florianschlotter cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT georgstachel cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT roberthollriegel cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT jenniferhommel cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT katrinbinneroussenek cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT martinmisfeld cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT holgerthiele cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT michaelaborger cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT davidholzhey cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement AT axellinke cardiacsurgerycomparedwithantibioticsonlyinpatientsdevelopinginfectiveendocarditisaftertranscatheteraorticvalvereplacement |