Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement

Abstract

Objectives: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level. Methods: Based on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018. Results: A total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1e3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78e2.00) and 1.40 (95% CI 1.34e1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensitymatched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70e2.04) %/year vs 1.71 (95% CI 1.58e1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96e1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3e49.3) than in SAVR patients with IE (32.8% 95% CI 28.6 e37.3; RR 1.32, 95% CI 1.08e1.60). Discussion: In a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.

Predictors of Prosthetic Valve Endocarditis following Transcatheter Aortic Valve Replacement: A Meta-Analysis

“…There were 106 fulltext articles assessed for eligibility after screening titles and abstracts, and we identified 35 studies that reported the incidence of PVE after TAVR. Finally, 8 articles [Kolte 2018;Amat-Santos 2015;Olsen 2015;Bjursten 2019;Fauchier 2020;Tabata 2020;Butt 2019;Regueiro 2016] were ultimately included in the present systematic review and metaanalysis. The main characteristics and the overall quality of the included studies are shown in Table 1.…”

“…Older age [Kolte 2018;Amat-Santos 2015;Bjursten 2019;Fauchier 2020;Tabata 2020;Butt 2019;Regueiro 2016] was associated with a lower risk of PVE after TVAR (RR 0.97, 95% CI: 0.95 to 0.99, P = .007), and men sex [Kolte 2018;Amat-Santos 2015;Olsen 2015;Bjursten 2019;Fauchier 2020;Tabata 2020;Butt 2019;Regueiro 2016] was identified as a predictor of PVE after TVAR (RR 1.53, 95% CI: 1.24 to 1.90, P = .0001), while diabetes [Kolte 2018;Amat-Santos 2015;Olsen 2015;Bjursten 2019;Fauchier 2020;Tabata 2020;Butt 2019;Regueiro 2016] (RR 1.08, 95% CI: 0.86 to 1.35, P = .51), COPD [Kolte 2018; 2).…”

Infective endocarditis on transcatheter aortic prosthesis: Are there differences with endocarditis on surgically implanted aortic bioprosthesis?

“…In patients at high baseline surgical risk, surgery may be contraindicated, or, in any case, the presence of the supporting stent makes the surgical procedure more complex. Some studies have analyzed the incidence of IETAVI, both in Spain [2,3] and in other countries [4][5][6]. They all agree on an annual incidence of approximately 1.4-1.6% and high mortality, ranging from 41.8% in the Swedish registry of Bjursten et al [4] to 47.2% in the Spanish multicenter study by Amat-Santos et al [3].…”

“…They also agree with regard to a high mean age of around 80 years, greater comorbidity (higher incidence of renal failure, previous cancer, higher Charlson index, etc. ), and the finding of enterococci, Staphylococcus aureus and coagulase-negative staphylococci as the most frequent microorganisms involved [2][3][4][5][6].…”

“…An aspect that has not been well studied yet is the possible difference between IETAVI and IE on surgical aortic valve replacement (IESAVR). Three multicenter registries carried out in different countries (USA, France and Sweden) [4][5][6] found a similar incidence of IE in both groups, but there is a lack of studies that had compared clinical features, treatment and mortality between these two types of IE. Only 1 French study, using an administrative database, has compared mortality between IETAVI and IESAVR, but without differentiating between biological and mechanical prostheses [5], finding no differences between them.…”