Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Abstract

Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020. Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

Operative management after transcatheter aortic valve replacement

“…Data from a multicenter registry in Germany showed that the incidence of root surgery was 14.5% during operations for THV IE [34], which is not more common than in native aortic valve IE (16.8%) [35]. The incidence of root abscess is also not different in IE after TAVR and conventional surgical valve replacement [36]. The decision to operate should be weighed against the surgical risk profile of the patient and made within the confines of an endocarditis team [37].…”

“…The mortality rates for TAVR IE are high, ranging from 16 to 36% for in-hospital mortality and 41-59% at 1-year [20,[25][26][27]. Notwithstanding, the results of operative management of TAVR IE are not significantly different than those of surgical valve IE [36]. In the report of the ESC-EORP EURO-ENDO (European Infective Endocarditis Registry), the strongest predictor of mortality in IE was not performing surgery when indications were present [38].…”