The Evolving Risk of Infective Endocarditis After Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Public Health

Background:

• Transcatheter aortic valve implantation (TAVI) is increasingly used in older adults with severe aortic stenosis.
• Infective endocarditis (IE) is a rare but serious complication following TAVI.
• Contemporary data on IE incidence and outcomes post-TAVI are limited.

Purpose of the Study:

• To analyze trends in the 1-year incidence of IE after TAVI in Medicare beneficiaries.
• To identify factors associated with IE incidence and outcomes post-TAVI.
• To evaluate changes in IE management and mortality over time.

Main Methods:

• Analysis of 280,073 Medicare beneficiaries undergoing TAVI from 2013-2022.
• Joinpoint regression to assess trends in IE incidence (annual percent change).
• Adjusted Cox models to evaluate IE associations with patient characteristics and 12-month outcomes.

Main Results:

• The 1-year IE incidence post-TAVI decreased from 20.0/1000 person-years in 2013 to 13.1/1000 in 2021, with a significant decline after 2018 (-12.1% APC).
• This decline correlated with reduced non-elective TAVI rates.
• While TAVI explant rates increased, 30-day mortality post-explant declined; however, overall 30-day risk-adjusted mortality for TAVI-IE remained unchanged.

Conclusions:

• Post-TAVI IE incidence in Medicare patients declined after 2019, associated with fewer non-elective procedures and TAVI expansion to lower-risk patients.
• TAVI explant rates are low but have recently increased.
• The persistent unchanged 30-day mortality for TAVI-IE highlights ongoing challenges in managing elderly patients post-TAVI.