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Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and
Isabelle D Ried1, Hazem Omran1, Max Potratz1
1Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
Summary
Prosthetic valve endocarditis (PVE) risk is similar after surgical (SAVR) and transcatheter aortic valve replacement (TAVI). TAVI patients with PVE may be treated with antibiotics alone, unlike SAVR patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Prosthetic valve endocarditis (PVE) is a severe complication following aortic valve replacement.
- Understanding PVE differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVI) is crucial for patient management.
- Existing data on comparative PVE aspects between SAVR and TAVI are limited.
Purpose of the Study:
- To compare pathological and therapeutic aspects of PVE in patients who underwent SAVR versus TAVI.
- To identify risk factors, pathogens, and outcomes associated with PVE in both SAVR and TAVI cohorts.
- To evaluate the impact of treatment strategies on mortality in PVE patients.
Main Methods:
- Retrospective analysis of 3447 SAVR and 2269 TAVI patients between 2012 and 2018.
- PVE diagnosis based on modified 2015 Duke criteria.
- Comparison of PVE incidence, risk factors, pathogens, and mortality between SAVR-PVE and TAVI-PVE groups.
Main Results:
- PVE incidence was comparable between SAVR (4.9/100 patient-years) and TAVI (2.4/100 patient-years), despite older age and higher comorbidity in TAVI patients.
- TAVI prostheses with polymer exhibited a 4.3-fold increased risk of PVE.
- One-year survival was higher in TAVI-PVE patients treated with antibiotics alone versus surgery; SAVR-PVE patients not operated on had poorer survival.
Conclusions:
- TAVI patients do not face a significantly higher risk of developing PVE compared to SAVR patients.
- TAVI-PVE patients may be candidates for antibiotic-only therapy, potentially due to the absence of a polymeric suture ring.
- Treatment strategies for PVE should be tailored, considering the type of valve replacement and patient-specific factors.
