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Open Access 03-01-2024 | Transcatheter Aortic Valve Implantation | Original Paper

Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement

Authors: Isabelle D. Ried, Hazem Omran, Max Potratz, Tanja K. Rudolph, Smita Scholtz, Sabine Bleiziffer, Cornelia Piper

Published in: Clinical Research in Cardiology | Issue 2/2024

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Abstract

Background and aims

Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI).

Methods

All patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE.

Results

PVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9% vs. 33.3%; p = 0.005). In SAVR-PVE patients, both therapies were comparable in terms of survival (p = 0.861). However, SAVR-PVE patients who were not operated, despite ESC-guideline recommendation, had significantly poorer one-year survival (p = 0.004).

Conclusion

TAVI patients did not have a significantly higher risk to develop PVE. Our data suggest that TAVI-PVE patients in contrast to SAVR-PVE patients can more often be treated with antibiotics only, presumably due to the lack of a polymeric suture ring.

Graphical abstract

Key question:
  • What are the differences between SAVR- and TAVI-PVE?
  • Are the current ESC guidelines for the treatment of SAVR-PVE also applicable to TAVI-PVE?
Key finding:
  • No significantly different PVE incidences after SAVR and TAVI
  • Significantly better one-year survival and significantly longer survival in TAVI-PVE treated with antibiotics only compared with additional surgical therapy
  • Higher risk to develop PVE after TAVI in patients carrying prostheses containing polymer particles
Take-home message
  • TAVI-PVE can often be treated successfully with antibiotics-only, even if surgery would have been indicated according to current guidelines.
  • SAVR-PVE patients benefit from surgical therapy, so guideline-compliant surgical indication should be made promptly and performed immediately
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Metadata
Title
Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement
Authors
Isabelle D. Ried
Hazem Omran
Max Potratz
Tanja K. Rudolph
Smita Scholtz
Sabine Bleiziffer
Cornelia Piper
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 2/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02356-4

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