TAVR Vs SVR
Endocarditis
Insights from the Rabin Medical Center endocarditis registry
Edward Itelman, Prof. Katia Orvin
• Endocarditis is a life-threatening condition affecting 0.51.5% of patients undergoing TAVR or SVR
• The all-cause mortality rates range up to 25%.
Introduction
• Data on the incidence, risk factors, and outcomes of IE
after TAVI vs surgical aortic valve replacement (SAVR) are
conflicting and sparse
• The current analysis set out to assess the clinical course
and survival of patients with endocarditis on surgical vs
transcatheter prosthetic aortic valves.
Overall
n
Population
SVR
TAVR
p
134
91
43
Age
69 (13.4)
64.7 (13.6)
77.9 (7.5)
<0.001
Male sex
90 (70.3)
65 (74.7)
25 (61)
0.168
Atrial Fibrillation
55 (44.4)
39 (46.4)
16 (40)
0.631
Diabetes Mellitus
50 (40.3)
35 (41.7)
15 (37.5)
0.805
S/P CVA
25 (20.2)
16 (19)
9 (22.5)
0.835
Hypertension
88 (71)
55 (65.5)
33 (82.5)
0.082
Baseline HGB
11.06 (1.89)
11.15 (1.99)
10.84 (1.6)
0.44
Baseline Createning
1.52 (1.1)
1.39 (1.02)
1.83 (1.24)
0.065
Baseline PLT
204 (91)
212 (88)
182 (96)
0.122
bacteria type
0.754
CONS
18 (13.4)
13 (14.3)
5 (11.6)
Enterococci
21 (15.7)
15 (16.5)
6 (14)
HACEK
10 (7.5)
8 (8.8)
2 (4.7)
Staph
19 (14.2)
11 (12.1)
8 (18.6)
streptococi
29 (21.6)
21 (23.1)
8 (18.6)
Other
37 (27.6)
23 (25.3)
14 (32.6)
Mortality
Does surgery
really make a
difference?
• Studies show that up to a third of PVE Endocarditis
undergo surgery.
• In our cohort, surgery was indicated, by a decision of the
institutional multidisciplinary Endocarditis Team in 22% of
the patients.
• An indication for surgery did not alter mortality in 120 days
HR = 0.76, CI 0.29-2.01, P = 0.582
• The type of prosthetic valve had no impact on survival
amongst these patients – HR = 1.34, CI 0.15-12.05, P =
0.791
• Some studies report an increased rate of Enterococcus
species in TAVR Endocarditis.
• Our study did not show a significant microbiological agent
in any patient type
Microbiological
findings
Overall
SVR
TAVR
bacteria type
p
0.754
CONS
18 (13.4)
13 (14.3)
5 (11.6)
Enterococci
21 (15.7)
15 (16.5)
6 (14)
HACEK
10 (7.5)
8 (8.8)
2 (4.7)
Staph
19 (14.2)
11 (12.1)
8 (18.6)
streptococi
29 (21.6)
21 (23.1)
8 (18.6)
Other
37 (27.6)
23 (25.3)
14 (32.6)
Microbiological
findings
Microbiological
findings
• Staphylococcus aureus endocarditis was a statistically
significant factor of mortality amongst SVR patients (HR =
3.47, CI 1.22 - 9.86, P =0.02) and borderline significant in
TAVR patients ( HR = 3.55 CI 1.00 - 12.63, P = 0.050)
• Interaction analysis proved insignificant – P = 0.915
Thank you