Infective Endocarditis After Aortic Valve Replacement: A Systematic Review and Meta-Analysis of Risks and Realities...

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Aortic valve replacement is crucial for valvular heart disease.
• Infective endocarditis (IE) is a rare but severe complication of aortic valve replacement.
• Transcatheter aortic valve replacement (TAVR) is increasingly used in younger, lower-risk patients, prompting comparative IE risk assessment against surgical aortic valve replacement (SAVR).

Purpose of the Study:

• To compare the incidence of infective endocarditis (IE) between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).
• To identify patient-specific and procedural risk factors associated with IE following TAVR and SAVR.

Main Methods:

• Systematic review and meta-analysis of 17 studies, including 118,443 patients, adhering to PRISMA guidelines.
• Quantitative analysis focused on studies reporting IE incidence after TAVR and SAVR.
• Pooled risk ratios and hazard ratios were calculated to assess IE risk and associated factors.

Main Results:

• No significant difference in IE risk was found between TAVR and SAVR (pooled log risk ratio: -0.006, p = 0.948), despite high heterogeneity.
• Major risk factors for IE included valve-in-valve procedures (RR = 2.88), pacemaker implantation (HR = 1.91), and chronic kidney disease (HR = 2.08).
• In-hospital mortality was high for both procedures (TAVR: 34.4%, SAVR: 31.8%), with over 60% mortality at five years.

Conclusions:

• TAVR and SAVR demonstrate comparable rates of infective endocarditis.
• Procedural and patient factors like valve-in-valve, pacemakers, and chronic kidney disease significantly influence IE risk.
• Enhanced monitoring for high-risk patients and potential reconsideration of guidelines for infected TAVR valve management are recommended due to high mortality.