Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

David del Val; Mohamed Abdel-Wahab; Norman Mangner; Eric Durand; Nikolaj Ihlemann; Marina Urena; Costanza Pellegrini; Francesco Giannini; Tomasz Gasior; Wojtek Wojakowski; Martin Landt; Vincent Auffret; Jan Malte Sinning; Asim N. Cheema; Luis Nombela-Franco; Chekrallah Chamandi; Francisco Campelo-Parada; Erika Munoz-Garcia; Howard C. Herrmann; Luca Testa; Kim Won-Keun; Juan Carlos Castillo; Alberto Alperi; Didier Tchetche; Antonio L. Bartorelli; Samir Kapadia; Stefan Stortecky; Ignacio Amat-Santos; Harindra C. 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 B. Ribeiro; Jose Armando Mangione; Fabio Sandoli de Brito; 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 R. Godinho; Fernando Alfonso; Helene Eltchaninoff; Lars Søndergaard; Dominique Himbert; Oliver Husser; Azeem Latib; Hervé Le Breton; Clement Servoz; Isaac Pascual; Saif Siddiqui; Paolo Olivares; Rosana Hernandez-Antolin; John G. Webb; Sandro Sponga; Raj Makkar; Annapoorna S. Kini; Marouane Boukhris; Philippe Gervais; Axel Linke; Lisa Crusius; David Holzhey; Josep Rodés-Cabau

doi:10.1016/j.jacc.2021.03.233

Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C. Herrmann, Luca TestaKim Won-Keun, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. 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 B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, 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 R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau

Medicine

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	2276-2287
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	77
Issue number	18
DOIs	https://doi.org/10.1016/j.jacc.2021.03.233
State	Published - May 11 2021

Keywords

TAVR
infective endocarditis
prosthetic valve endocarditis
stroke
transcatheter aortic valve implantation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2021.03.233

Cite this

del Val, D., Abdel-Wahab, M., Mangner, N., Durand, E., Ihlemann, N., Urena, M., Pellegrini, C., Giannini, F., Gasior, T., Wojakowski, W., Landt, M., Auffret, V., Sinning, J. M., Cheema, A. N., Nombela-Franco, L., Chamandi, C., Campelo-Parada, F., Munoz-Garcia, E., Herrmann, H. C., ... Rodés-Cabau, J. (2021). Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 77(18), 2276-2287. https://doi.org/10.1016/j.jacc.2021.03.233

del Val, D, Abdel-Wahab, M, Mangner, N, Durand, E, Ihlemann, N, Urena, M, Pellegrini, C, Giannini, F, Gasior, T, Wojakowski, W, Landt, M, Auffret, V, Sinning, JM, Cheema, AN, Nombela-Franco, L, Chamandi, C, Campelo-Parada, F, Munoz-Garcia, E, Herrmann, HC, Testa, L, Won-Keun, K, Castillo, JC, Alperi, A, Tchetche, D, Bartorelli, AL, Kapadia, S, Stortecky, S, Amat-Santos, I, Wijeysundera, HC, Lisko, J, Gutiérrez-Ibanes, E, Serra, V, Salido, L, Alkhodair, A, Livi, U, Chakravarty, T, Lerakis, S, Vilalta, V, Regueiro, A, Romaguera, R, Kappert, U, Barbanti, M, Masson, JB, Maes, F, Fiorina, C, Miceli, A, Kodali, S, Ribeiro, HB, Mangione, JA, Sandoli de Brito, F, Actis Dato, GM, Rosato, F, Ferreira, MC, Correia de Lima, V, Colafranceschi, AS, Abizaid, A, Marino, MA, Esteves, V, Andrea, J, Godinho, RR, Alfonso, F, Eltchaninoff, H, Søndergaard, L, Himbert, D, Husser, O, Latib, A, Le Breton, H, Servoz, C, Pascual, I, Siddiqui, S, Olivares, P, Hernandez-Antolin, R, Webb, JG, Sponga, S, Makkar, R, Kini, AS, Boukhris, M, Gervais, P, Linke, A, Crusius, L, Holzhey, D & Rodés-Cabau, J 2021, 'Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement', Journal of the American College of Cardiology, vol. 77, no. 18, pp. 2276-2287. https://doi.org/10.1016/j.jacc.2021.03.233

@article{281701340d2a42ffbfd05ecd16e4ad3e,

title = "Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement",

abstract = "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.",

keywords = "TAVR, infective endocarditis, prosthetic valve endocarditis, stroke, transcatheter aortic valve implantation",

author = "{del Val}, David and Mohamed Abdel-Wahab and Norman Mangner and Eric Durand and Nikolaj Ihlemann and Marina Urena and Costanza Pellegrini and Francesco Giannini and Tomasz Gasior and Wojtek Wojakowski and Martin Landt and Vincent Auffret and Sinning, {Jan Malte} and Cheema, {Asim N.} and Luis Nombela-Franco and Chekrallah Chamandi and Francisco Campelo-Parada and Erika Munoz-Garcia and Herrmann, {Howard C.} and Luca Testa and Kim Won-Keun and Castillo, {Juan Carlos} and Alberto Alperi and Didier Tchetche and Bartorelli, {Antonio L.} and Samir Kapadia and Stefan Stortecky and Ignacio Amat-Santos and Wijeysundera, {Harindra C.} and John Lisko and Enrique Guti{\'e}rrez-Ibanes and Vicen{\c c} Serra and Luisa Salido and Abdullah Alkhodair and Ugolino Livi and Tarun Chakravarty and Stamatios Lerakis and Victoria Vilalta and Ander Regueiro and Rafael Romaguera and Utz Kappert and Marco Barbanti and Masson, {Jean Bernard} and Fr{\'e}d{\'e}ric Maes and Claudia Fiorina and Antonio Miceli and Susheel Kodali and Ribeiro, {Henrique B.} and Mangione, {Jose Armando} and {Sandoli de Brito}, Fabio and {Actis Dato}, {Guglielmo Mario} and Francesco Rosato and Ferreira, {Maria Cristina} and {Correia de Lima}, Valter and Colafranceschi, {Alexandre Siciliano} and Alexandre Abizaid and Marino, {Marcos Antonio} and Vinicius Esteves and Julio Andrea and Godinho, {Roger R.} and Fernando Alfonso and Helene Eltchaninoff and Lars S{\o}ndergaard and Dominique Himbert and Oliver Husser and Azeem Latib and {Le Breton}, Herv{\'e} and Clement Servoz and Isaac Pascual and Saif Siddiqui and Paolo Olivares and Rosana Hernandez-Antolin and Webb, {John G.} and Sandro Sponga and Raj Makkar and Kini, {Annapoorna S.} and Marouane Boukhris and Philippe Gervais and Axel Linke and Lisa Crusius and David Holzhey and Josep Rod{\'e}s-Cabau",

note = "Funding Information: Dr. del Val was supported by a research grant from the Fundaci{\'o}n Alfonso Martin Escudero (Madrid, Spain). Dr. Mangner has received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, and Bayer, outside of the submitted work. Dr. Husser has received personal fees from Boston Scientific; and has received payments from Abbott. Dr. Sinning has received speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside of the submitted work. Dr. Won-Keun has received personal fees from Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, and Meril, outside of the submitted work. Dr. Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Edwards Lifesciences and Medtronic. Dr. Stortecky has received grants to the institution from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and has received personal fees from Boston Scientific, BTG, and Teleflex, outside of the submitted work. Dr. Tchetche has received consulting fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Webb has received consulting fees from Edwards Lifesciences and St. Jude Medical. Dr. Makkar has received research grants from Edwards Lifesciences, Medtronic, Abbott, Capricor, and St. Jude Medical; has served as a proctor for Edwards Lifesciences; and has received consulting fees from Medtronic. Dr. Lerakis has received consulting fees from Edwards Lifesciences. Dr. de Brito Jr. has received honoraria from Medtronic and Edwards Lifesciences for symposium speeches and proctoring cases. Dr. Le Breton has received lecture fees from Edwards Lifesciences, outside of the submitted work. Dr. Linke has received personal fees from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, AstraZeneca, Novartis, Pfizer, Abiomed, Bayer, and Boehringer, outside the submitted work. Dr. Rod{\'e}s-Cabau holds the Research Chair “Fondation Famille Jacques Larivi{\`e}re” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = may,

day = "11",

doi = "10.1016/j.jacc.2021.03.233",

language = "English (US)",

volume = "77",

pages = "2276--2287",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "18",

}

TY - JOUR

T1 - Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

AU - del Val, David

AU - Abdel-Wahab, Mohamed

AU - Mangner, Norman

AU - Durand, Eric

AU - Ihlemann, Nikolaj

AU - Urena, Marina

AU - Pellegrini, Costanza

AU - Giannini, Francesco

AU - Gasior, Tomasz

AU - Wojakowski, Wojtek

AU - Landt, Martin

AU - Auffret, Vincent

AU - Sinning, Jan Malte

AU - Cheema, Asim N.

AU - Nombela-Franco, Luis

AU - Chamandi, Chekrallah

AU - Campelo-Parada, Francisco

AU - Munoz-Garcia, Erika

AU - Herrmann, Howard C.

AU - Testa, Luca

AU - Won-Keun, Kim

AU - Castillo, Juan Carlos

AU - Alperi, Alberto

AU - Tchetche, Didier

AU - Bartorelli, Antonio L.

AU - Kapadia, Samir

AU - Stortecky, Stefan

AU - Amat-Santos, Ignacio

AU - Wijeysundera, Harindra C.

AU - Lisko, John

AU - Gutiérrez-Ibanes, Enrique

AU - Serra, Vicenç

AU - Salido, Luisa

AU - Alkhodair, Abdullah

AU - Livi, Ugolino

AU - Chakravarty, Tarun

AU - Lerakis, Stamatios

AU - Vilalta, Victoria

AU - Regueiro, Ander

AU - Romaguera, Rafael

AU - Kappert, Utz

AU - Barbanti, Marco

AU - Masson, Jean Bernard

AU - Maes, Frédéric

AU - Fiorina, Claudia

AU - Miceli, Antonio

AU - Kodali, Susheel

AU - Ribeiro, Henrique B.

AU - Mangione, Jose Armando

AU - Sandoli de Brito, Fabio

AU - Actis Dato, Guglielmo Mario

AU - Rosato, Francesco

AU - Ferreira, Maria Cristina

AU - Correia de Lima, Valter

AU - Colafranceschi, Alexandre Siciliano

AU - Abizaid, Alexandre

AU - Marino, Marcos Antonio

AU - Esteves, Vinicius

AU - Andrea, Julio

AU - Godinho, Roger R.

AU - Alfonso, Fernando

AU - Eltchaninoff, Helene

AU - Søndergaard, Lars

AU - Himbert, Dominique

AU - Husser, Oliver

AU - Latib, Azeem

AU - Le Breton, Hervé

AU - Servoz, Clement

AU - Pascual, Isaac

AU - Siddiqui, Saif

AU - Olivares, Paolo

AU - Hernandez-Antolin, Rosana

AU - Webb, John G.

AU - Sponga, Sandro

AU - Makkar, Raj

AU - Kini, Annapoorna S.

AU - Boukhris, Marouane

AU - Gervais, Philippe

AU - Linke, Axel

AU - Crusius, Lisa

AU - Holzhey, David

AU - Rodés-Cabau, Josep

N1 - Funding Information: Dr. del Val was supported by a research grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). Dr. Mangner has received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, and Bayer, outside of the submitted work. Dr. Husser has received personal fees from Boston Scientific; and has received payments from Abbott. Dr. Sinning has received speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received research grants from Boston Scientific, Edwards Lifesciences, and Medtronic, outside of the submitted work. Dr. Won-Keun has received personal fees from Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, and Meril, outside of the submitted work. Dr. Herrmann has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Edwards Lifesciences and Medtronic. Dr. Stortecky has received grants to the institution from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and has received personal fees from Boston Scientific, BTG, and Teleflex, outside of the submitted work. Dr. Tchetche has received consulting fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Webb has received consulting fees from Edwards Lifesciences and St. Jude Medical. Dr. Makkar has received research grants from Edwards Lifesciences, Medtronic, Abbott, Capricor, and St. Jude Medical; has served as a proctor for Edwards Lifesciences; and has received consulting fees from Medtronic. Dr. Lerakis has received consulting fees from Edwards Lifesciences. Dr. de Brito Jr. has received honoraria from Medtronic and Edwards Lifesciences for symposium speeches and proctoring cases. Dr. Le Breton has received lecture fees from Edwards Lifesciences, outside of the submitted work. Dr. Linke has received personal fees from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, AstraZeneca, Novartis, Pfizer, Abiomed, Bayer, and Boehringer, outside the submitted work. Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received institutional research grants from Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/5/11

Y1 - 2021/5/11

N2 - 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.

AB - 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.

KW - TAVR

KW - infective endocarditis

KW - prosthetic valve endocarditis

KW - stroke

KW - transcatheter aortic valve implantation

UR - http://www.scopus.com/inward/record.url?scp=85104583299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85104583299&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.03.233

DO - 10.1016/j.jacc.2021.03.233

M3 - Article

C2 - 33958124

AN - SCOPUS:85104583299

SN - 0735-1097

VL - 77

SP - 2276

EP - 2287

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 18

ER -

Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement

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