Infective Endocarditis After Aortic Valve Replacement: A Systematic Review and Meta-Analysis of Risks and Realities in Transcatheter Versus Surgical Repair

TL;DR

This study compares the risk of infective endocarditis after transcatheter and surgical aortic valve replacement, finding similar overall risks but important differences in specific risk factors.

Contribution

The study provides a systematic review and meta-analysis comparing IE risks between TAVR and SAVR, highlighting distinct risk profiles and mortality rates.

Findings

TAVR and SAVR have similar pooled IE incidence rates with no significant difference.

Valve-in-valve procedures, pacemaker implantation, and chronic kidney disease are major IE risk factors.

In-hospital mortality is high for both TAVR and SAVR, with over 60% mortality at five years.

Abstract

Aortic valve replacement is an effective intervention for valvular heart disease. However, it carries a rare but serious risk of infective endocarditis (IE). With the expanding use of transcatheter aortic valve replacement (TAVR) in younger, lower-risk patients, it is critical to evaluate its IE risk compared with that of surgical aortic valve replacement (SAVR). We hypothesized that TAVR and SAVR have comparable IE incidence rates but distinct risk profiles influenced by procedural and patient-specific factors.

A total of 17 articles were included in our study. Seventeen studies were included in the qualitative synthesis, and seven studies (118,443 patients) were included in the quantitative analysis. Studies focusing on the incidence of IE after TAVR and SAVR were included. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered.

There was no significant difference in IE risk between TAVR and SAVR (pooled log risk ratio (RR): -0.006, 95% CI (-0.198, 0.185), p = 0.948), although risk estimates varied widely (-1.14 to -1.57), with high heterogeneity (I² = 96%). Major risk factors included valve-in-valve procedures (RR = 2.88), pacemaker implantation (hazard ratio (HR) = 1.91), and chronic kidney disease (HR = 2.08). In-hospital mortality was high (TAVR: 34.4%, SAVR: 31.8%), with over 60% mortality at five years.

TAVR and SAVR have similar rates of IE, but differences in data highlight the need for consistent reporting and personalized risk assessment. Better monitoring, especially for pacemakers or patients with kidney disease, could help improve outcomes. Since prosthetic valve infections have high death rates, guidelines for removing infected TAVR valves may need to be reconsidered.

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