688 - Incidence and Risk Factors for Prosthetic Valve Endocarditis Following TAVR: 2015-2019

Transcatheter aortic valve replacement (TAVR) is increasingly used for lower risk patients. Incidence of TAVR endocarditis ranges from 0.2% to 3.3%. The purpose of this study was to determine local incidence and risk factors of prosthetic valve infective endocarditis (PVIE) in a contemporary cohort.

Methods:

IRB approved retrospective, nested case-control study evaluated the 1-year incidence and risk factors for PVIE among TAVR recipients from 2015 to 2019. Inclusion: ≥ 18 years, TAVR procedure at Henry Ford Health System. Exclusion: repeat TAVR. PVIE cases were matched with controls who did not experience PVIE. PVIE defined as diagnosis documentation in the electronic medical record.Figure 1. Study Design


Results:

23/1266 patients were identified as cases corresponding to a 1-year incidence of 1.82%. The median time to PVIE was 127 days and 35% occurred within 60 days. The most frequently isolated organisms were streptococci (26%), MRSA (13%), and MSSA (13%).  Baseline demographics and comorbidities for 23 PVIE cases and 161 controls are displayed in Table 1. Significant risk factors for PVIE in bivariate analysis included STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality), median: 4.1 controls and 6.4 cases (p = 0.012). Age, BMI, and comorbidities were not significantly different. Diabetes was notably more frequent among cases (36% vs 48%, p = 0.274). Patients with PVIE had more post-op RBC transfusions (5% vs 21.7% p = 0.003), ECG changes (23% vs 43.5%, p = 0.035), heart block (15.5% vs 34.8%, p = 0.038), longer length of stay (2 days, range 1 to 4 vs 4 to 11, p = 0.004), and thirty-day readmission (10.6% vs 52.2%, p < 0.001).  Results displayed in Table 2.Table 1. Patient Characteristics and Risk Factor Analysis
Table 2. Additional Outcomes


Conclusion: The results from this study give insight to the local incidence, microbiology, and risk of PVIE following TAVR. Future directions include a larger evaluation of modifiable risks such as diabetes management and examining the heart block patients who received permanent pacemaker implants.