In-hospital infection (IHI) after transcatheter aortic valve implantation (TAVI) has
received little attention, although it may have a significant effect on outcomes and
costs because of prolonged hospital stay. Therefore, the aim of this study was to
determine the incidence, type, predictors, and prognostic effects of IHI after TAVI.
This study included 298 consecutive patients from 2 centers who underwent TAVI from
November 2005 to November 2011. IHI during the hospital stay was defined on the basis
of symptoms and signs assessed by the attending physician in the cardiac care unit
or medium care unit in combination with all technical examinations performed to confirm
infection. IHI after TAVI was observed in 58 patients (19.5%): urinary tract infections
in 25 patients (43.1%), pneumonia in 12 patients (20.7%), and access-site infections
in 7 patients (12.1%). In 12 patients (20.7%), the site of infection could not be
determined, and 2 patients (3.4%) had multiple infection sites. Multivariate analysis
revealed that surgical access through the femoral artery was the most important determinant
of infection (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.02 to 17.19), followed
by perioperative major stroke (OR 3.21, 95% CI 1.01 to 9.52) and overweight (body
mass index ≥25 kg/m2; OR 2.27, 95% CI 1.12 to 4.59). The length of hospital stay in patients with IHIs
was 15.0 days (interquartile range 8.0 to 22.0) compared with 7.0 days (interquartile
range 4.0 to 10.0) in patients without infections (p <0.0001). Kaplan-Meier estimates
of survival at 1 year were 76.6% and 74.4% (log-rank, p = 0.61), respectively. Unadjusted
and adjusted OR analysis revealed that IHI did not predict mortality at 30 days (OR
1.27, 95% CI 0.49 to 3.30) or at 1 year (hazard ratio 1.24, 95% CI 0.68 to 2.25).
In conclusion, IHI occurred in 19.5% of the patients. Patient-related and, more important, procedure-related
variables play a role in the occurrence of infection, indicating that improvements
in the execution of TAVI may lead to a reduction of this complication.
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References
- Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med. 2010; 363: 1597-1607
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI).Eur Heart J. 2008; 29: 1463-1470
- Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies.J Am Coll Cardiol. 2012; 59: 2317-2326
- Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program.J Am Coll Surg. 2004; 199: 531-537
- Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.Circulation. 2002; 106: 3006-3008
- Outcomes after transcatheter aortic valve implantation with both Edwards-SAPIEN and CoreValve devices in a single center: the Milan experience.JACC Cardiovasc Interv. 2010; 3: 1110-1121
- Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience.J Am Coll Cardiol. 2010; 55: 1080-1090
- Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients.J Cardiothorac Vasc Anesth. 2011; 25: 1036-1043
- Infective complications after transcatheter aortic valve implantation: results from a single centre.Neth Heart J. 2012; 20: 360-364
- Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium.Eur Heart J. 2011; 32: 205-217
- Fungal endocarditis after transfemoral aortic valve implantation.Catheter Cardiovasc Interv. 2011; 78: 1017-1019
- Aortic valve replacement and mitral valve repair as treatment of complications after percutaneous core valve implantation.J Thorac Cardiovasc Surg. 2009; 138: 1025-1027
- Endocarditis after transfemoral aortic valve implantation in a patient with Osler-Weber-Rendu syndrome.Interact Cardiovasc Thorac Surg. 2012; 15: 553-554
- Two cases of aneurysm of the anterior mitral valve leaflet associated with transcatheter aortic valve endocarditis: a mere coincidence?.J Thorac Cardiovasc Surg. 2010; 140: e36-e38
- Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation.JACC Cardiovasc Interv. 2012; 5: 489-496
- Patients with aortic stenosis referred for TAVI: treatment decision, in-hospital outcome and determinants of survival.Neth Heart J. 2012; 20: 16-23
- Colombian experience with transcatheter aortic valve implantation of medtronic CoreValve.Tex Heart Inst J. 2012; 39: 351-358
- Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy.Am J Med. 1987; 82: 703-713
- Nutritional anaemias. Report of a WHO scientific group.World Health Organ Tech Rep Ser. 1968; 405: 5-37
- Effect of body mass index on short- and long-term outcomes after transcatheter aortic valve implantation.Am J Cardiol. 2013; 111: 231-236
- Injuries associated with anaesthesia. A global perspective.Br J Anaesth. 2005; 95: 95-109
- The inguinal skin: an important site of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae.Infect Control Hosp Epidemiol. 2010; 31: 427-428
- Colonization with Staphylococcus aureus in Swedish nursing homes: a cross-sectional study.Scand J Infect Dis. 2012; 44: 3-8
- Multidrug-resistant bacteria colonization amongst patients newly admitted to a geriatric unit: a prospective cohort study.J Infect. 2012; 65: 109-118
- 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: Developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.J Thorac Cardiovasc Surg. 2012; 144: e29-e84
- Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation.Am J Cardiol. 2012; 110: 1361-1367
- Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of Aortic Transcatheter Valve) trial.J Am Coll Cardiol. 2012; 60: 1043-1052
- The impact of peripheral arterial disease on early outcome after transcatheter aortic valve implantation: results from the German Transcatheter Aortic Valve Interventions Registry.Am Heart J. 2012; 164: 102-110
- Post-stroke infection: a systematic review and meta-analysis.BMC Neurol. 2011; 11: 110
Article info
Publication history
Published online: April 08, 2013
Accepted:
February 28,
2013
Received in revised form:
February 28,
2013
Received:
January 15,
2013
Footnotes
See page 109 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
