Infective endocarditis after transcatheter aortic valve implantation: risk factors and mortality impact in a...

Infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) is an uncommon but clinically devastating complication. We aimed to identify risk factors for TAVI-IE and to estimate its association with all-cause mortality.

We conducted a case-control study including patients who underwent TAVI at Haukeland University Hospital, Norway, between 2012 and 2023. Patients who developed TAVI-IE (n=71) were compared with age-matched and sex-matched controls without IE (n=213; 1:3 ratio). Death was treated as a competing event in analyses of IE, and we estimated the subdistribution HRs (SHR) for IE using Fine-Gray competing risk regression. Cox regression models with IE as a time-dependent covariate assessed the impact of infection on mortality.The incidence of TAVI-IE was 1.2% per patient-year with a median time from TAVI to infection of 13 months (IQR 4-29). In multivariable competing risk analysis, diabetes mellitus remained an independent predictor of TAVI-IE (SHR 2.08, 95% CI 1.19 to 3.65, p=0.010). Obesity (27% vs 15%, p=0.019) and balloon-expandable valve use (28% vs 13%, p=0.003) were more often observed in patients with TAVI-IE. Enterococcus faecalis was the most frequent pathogen (30%). TAVI-IE was associated with an approximately twofold increase in all-cause mortality (adjusted HR 2.13, 95% CI 1.48 to 3.07, p<0.001) with the highest risk in early infections.

TAVI-IE is an infrequent but severe complication associated with excess mortality. Diabetes mellitus was the dominant independent risk factor and E. faecalis the leading pathogen. These findings may help target monitoring and prevention in patients at the highest risk.