Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

David del Val (1) , Mohamed Abdel-Wahab (2) , Norman Mangner (2, 3) , Eric Durand (4) , Nikolaj Ihlemann , Marina Urena (5) , Costanza Pellegrini , Francesco Giannini , Tomasz Gasior , Wojtek Wojakowski , Martin Landt , Vincent Auffret (6, 7) , Jan Malte Sinning , Asim Cheema , Luis Nombela-Franco , Chekrallah Chamandi (8) , Francisco Campelo-Parada (9) , Erika Munoz-Garcia , Howard Herrmann , Luca Testa , Kim Won-Keun , Juan Carlos Castillo , Alberto Alperi , Didier Tchetche (10) , Antonio Bartorelli , Samir Kapadia , Stefan Stortecky , Ignacio Amat-Santos , Harindra Wijeysundera , John Lisko , Enrique Gutiérrez-Ibanes , Vicenç Serra , Luisa Salido , Abdullah Alkhodair , Ugolino Livi , Tarun Chakravarty , Stamatios Lerakis , Victoria Vilalta , Ander Regueiro , Rafael Romaguera , Utz Kappert , Marco Barbanti , Jean-Bernard Masson , Frédéric Maes , Claudia Fiorina , Antonio Miceli , Susheel Kodali , Henrique Ribeiro , Jose Armando Mangione , Fabio Sandoli de Brito Jr , Guglielmo Mario Actis Dato , Francesco Rosato , Maria-Cristina Ferreira , Valter Correia de Lima , Alexandre Siciliano Colafranceschi , Alexandre Abizaid , Marcos Antonio Marino , Vinicius Esteves , Julio Andrea , Roger Godinho , Fernando Alfonso , Helene Eltchaninoff (4) , Lars Søndergaard , Dominique Himbert , Oliver Husser , Azeem Latib , Hervé Le Breton (6, 7) , Clement Servoz , Isaac Pascual , Saif Siddiqui , Paolo Olivares , Rosana Hernandez-Antolin , John Webb , Sandro Sponga , Raj Makkar , Annapoorna Kini , Marouane Boukhris , Philippe Gervais , Axel Linke , Lisa Crusius , David Holzhey (2) , Josep Rodés-Cabau (1)

1 ULaval - Université Laval [Québec]
2 Leipzig University / Universität Leipzig
3 TU Dresden - Technische Universität Dresden = Dresden University of Technology
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
7 LTSI - Laboratoire Traitement du Signal et de l'Image
8 HEGP - Hôpital Européen Georges Pompidou [APHP]
9 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
10 Clinique Pasteur [Toulouse]

Background: Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR).Objectives: The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization.Methods: Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]).Results: A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47).Conclusions: Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.

Mots clés: TAVR; infective endocarditis; prosthetic valve endocarditis; stroke; transcatheter aortic valve implantation

Domaines: Ingénierie biomédicale

David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, et al.. Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 2021, 77 (18), pp.2276-2287. ⟨10.1016/j.jacc.2021.03.233⟩. ⟨hal-03244599⟩