Respiratory and Urinary Tract Infections Common in TAVR Patients Interview with:

Luis Nombela-Franco, MD, PhD Structural cardiology program. Interventional Cardiology department. Hospital Clínico San Carlos, Cardiovascular Institute Madrid, Spain

Dr. Nombela Franco

Luis Nombela-Franco, MD, PhD
Structural cardiology program.
Interventional Cardiology department.
Hospital Clínico San Carlos, Cardiovascular Institute
Madrid, Spain

(Dr. Nombela-Franco, has a special interest in interest on percutaneous treatment of structural heart disease and coronary interventions with special focus on chronic total occlusion) What is the background for this study?

Dr. Nombela-Franco: In-hospital infections are one of the most common complications that may occur following medical and surgical admissions, significantly impacted length of hospital stay, costs and clinical outcomes. In addition, approximately one third of hospital-acquired infections are preventable.

Transcatheter aortic valve replacement (TAVR) is currently the standard of care for symptomatic patients with severe aortic stenosis deemed at high surgical risk or inoperable. Patients undergoing TAVR have several comorbidities and the invasive (although less invasive the surgical treatment) nature of the procedure and peri-operative care confers a high likelihood in-hospital infections in such patients. This study analyzed the incidence, predictive factors and impact of in-hospital infections in patients undergoing transcatheter aortic valve implantation. What are the main findings?

Dr. Nombela-Franco: The major findings of our study were that in-hospital infections in patients undergoing TAVR are frequent (~20%) and this complication is associated with poorer in-hospital (longer hospital stay) and long-term outcomes (overall mortality and readmission rate). The infection´s origin were mainly respiratory and urinary, occurring in the early (≤72hrs) or late (>72hrs) periprocedural period, respectively. The gram-negative organism were more commonly isolated than gram-positive organism. The factors associated with in-hospital infection were peri-procedural complications and general anesthesia rather than clinical baseline characteristics. What recommendation do you have for future research as a result of this study?

Dr. Nombela-Franco: The findings of this study underlines the importance of in-hospital infections following TAVR and future research will have to investigate the appropriate strategies to reduce this important complication.

Firstly, they may be focused on whether a less invasive procedure such as a minimalist approach (conscious sedation without transesopheal echocardiogram guidance and early hospital discharge) will impact in-hospital infection rate.

Secondly, a reduction of peri-procedural complications such as vascular and bleeding complications, may probably translate into a reduction of in-hospital infection. Lastly, whether preventive strategies such as more aggressive antibiotics prophylaxis or control measures in the coronary care environment could also translate in a reduction of peri-procedural infections.

Incidence, Causes and Impact of In-Hospital Infections Following Transcatheter Aortic Valve Implantation
Gabriela Tirado-Conte, MD, Afonso B. Freitas-Ferraz, MD, Luis Nombela-Franco, MD, PhD, Pilar Jimenez-Quevedo, MD, PhD,Corina Biagioni, MD,Ana Cuadrado, MD, Ivan Nuñez-Gil, MD, PhD,Pablo Salinas, MD, PhD,Nieves Gonzalo, MD, PhD,Carlos Ferrera, MD,David Vivas, MD, PhD,Javier Higueras, MD, PhD,Ana Viana-Tejedor, MD, PhD,Maria Jose Perez-Vizcayno, MD,  Isidre Vilacosta, MD, PhD,Javier Escaned, MD, PhD,Antonio Fernandez-Ortiz, MD, PhD, Carlos Macaya, MD, PhD

The American Journal of Cardiology
Available online 14 May 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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