Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement

Area of Science:

• Cardiology
• Infectious Diseases
• Prosthetic Valve Complications

Background:

• Limited comparative data exist on infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).
• Understanding IE presentation, microbiology, management, and outcomes after these procedures is crucial for patient care.

Purpose of the Study:

• To compare the clinical characteristics, microbiological profiles, management strategies, and outcomes of IE in patients who underwent SAVR versus TAVR.
• To identify differences and similarities in IE occurring on surgical bioprostheses (SB) compared to transcatheter heart valves.

Main Methods:

• Utilized data from the "Infectious Endocarditis after TAVR International" and "International Collaboration on Endocarditis" registries.
• Employed a 1:1 matched cohort analysis comparing patients with IE affecting SAVR (specifically surgical bioprostheses) and TAVR prostheses.
• Included 1688 patients, with a matched population for comparative analysis.

Main Results:

• The SAVR group (surgical bioprosthesis) showed higher rates of new moderate/severe aortic regurgitation (43.4% vs 13.5%) and perivalvular extension (47.9% vs 27%) compared to TAVR.
• Fewer vegetations were diagnosed in the SAVR group (62.5% vs 82%), and Staphylococcus aureus was less common (13.4% vs 22%).
• Despite a higher rate of re-operation in the SAVR group (44.4% vs 27.3%), 1-year mortality was similar (46.5% vs 44.8%).

Conclusions:

• Significant differences exist in the clinical presentation, causative microorganisms, and treatment approaches for IE between SAVR (SB) and TAVR.
• Despite these variations, both patient groups experience high and comparable 1-year mortality rates following infective endocarditis.