Cardiac implantable electronic device and associated risk of infective endocarditis in patients undergoing aortic valve replacement

Europace. 2018 Oct 1;20(10):e164-e170. doi: 10.1093/europace/eux360.

Abstract

Aims: Patients undergoing aortic valve replacement (AVR) are at increased risk of infective endocarditis (IE) as are patients with a cardiac implantable electronic device (CIED). However, few data exist on the IE risk after AVR surgery in patients with a CIED.

Methods and results: Using the Danish administrative registries, we identified patients undergoing AVR from January 1996 to December 2015. Patients were categorized by CIED and non-CIED and followed up till hospitalization due to IE, death, 10 years after AVR discharge, end of study period (December 2015) or emigration, whichever came first. Using multivariable-adjusted Cox proportional hazard analysis with time-varying exposure, we investigated whether CIED was associated with an increased risk of IE. We included 15 538 patients (median age 71.4 years, 25th-75th percentiles 63.7-77.1, and 65.2% male). There were 890 patients with a CIED; 531 of these received their device during the AVR hospitalization and 14 648 patients with no CIED. The crude incidence rate of IE was 149.4/10 000 person-years in the CIED group and 74.3/10 000 person-years in the non-CIED group. Overall, CIED was associated with an increased risk of IE (hazard ratio 1.66, 95% confidence interval 1.27-2.17). There was no difference in associated IE according to the timing of CIED (P for interaction = 0.21 for CIED implantation before vs. in conjunction with AVR surgery).

Conclusion: Patients with a CIED who underwent surgery for AVR were associated with an increased risk of IE compared with patients without a CIED. The association was independent of the timing of CIED implantation (before or in conjunction with AVR surgery).

MeSH terms

  • Aged
  • Aortic Valve Insufficiency / surgery*
  • Aortic Valve Stenosis / surgery*
  • Defibrillators, Implantable / statistics & numerical data*
  • Denmark / epidemiology
  • Endocarditis / epidemiology*
  • Female
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pacemaker, Artificial / statistics & numerical data*
  • Postoperative Complications / epidemiology*
  • Proportional Hazards Models
  • Prosthesis Implantation
  • Risk Factors