Infective Endocarditis After TAVR-Surgical Challenges and Outcomes

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) is a serious complication.
• Surgical explantation of infected transcatheter heart valves (THV) is complex and linked to high mortality.
• Limited data exists on risk factors for perioperative death and long-term outcomes.

Purpose of the Study:

• To identify predictors of mortality in patients undergoing surgical aortic valve replacement (SAVR) for IE after TAVR.

Main Methods:

• A case-control study compared 15 patients who died perioperatively (cases) with 35 survivors (controls) undergoing SAVR for IE post-TAVR.
• Patients were treated between February 2008 and December 2023.
• Long-term outcomes were assessed for hospital survivors.

Main Results:

• Cases showed lower left ventricular function and higher logistic EuroSCORE and STS-PROM pre-surgery.
• Postoperative dialysis was more frequent in cases (44% vs. 25.7%).
• 30-day survival was 79.8%, and 1-year survival was 67.4%; 31 of 35 hospital survivors remained alive at follow-up.

Conclusions:

• SAVR for IE post-TAVR has substantial early mortality (18.1% at 30 days, 32.6% at 1 year).
• Elevated preoperative risk scores and need for postoperative dialysis are associated with perioperative death.
• Hospital survivors experience favorable long-term outcomes, with most achieving independent living.