Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Medical Device Technology

Background:

• Prosthetic valve endocarditis (PVE) is a critical complication after aortic valve replacement (AVR), impacting both transcatheter (TAVR) and surgical (SAVR) procedures.
• Understanding PVE's incidence, risk factors, and outcomes is crucial given the increasing use of TAVR in diverse patient populations.

Purpose of the Study:

• To characterize the incidence, risk factors, microbiological profile, and outcomes of PVE in patients who underwent TAVR or SAVR.
• To compare PVE rates and characteristics between TAVR and SAVR approaches.

Main Methods:

• Analysis of a pooled cohort from the PARTNER trials and registries, including patients with severe aortic stenosis treated with TAVR or SAVR.
• PVE adjudication using modified Duke Criteria, with analysis of incidence, timing, causative organisms, and association with all-cause mortality.

Main Results:

• PVE occurred in 1.3% of 8530 patients (5.06 events per 1000 person-years), with similar incidence between TAVR and SAVR.
• Baseline cirrhosis, pulmonary disease, and renal insufficiency were associated with increased PVE risk.
• PVE was strongly linked to all-cause mortality (HR, 4.4), with Staphylococcus being more common after SAVR.

Conclusions:

• PVE remains a rare but often fatal complication following modern AVR, with no significant difference in incidence or predictors between TAVR and SAVR.
• The findings underscore the importance of monitoring for PVE in all AVR patients, regardless of the procedure type.