# Endocarditis and other indications for open-heart surgery after a transcatheter aortic valve implant

## TL;DR

This study examines the outcomes of open-heart surgery in patients who had a TAVI and later developed complications like endocarditis.

## Contribution

The study provides insights into the effectiveness of open-heart surgery for rare TAVI complications.

## Key findings

- Definite endocarditis occurred in 0.5% of all TAVI procedures.
- Open-heart surgery had a 76% 2-year survival rate for patients with definite endocarditis.
- Medical treatment for endocarditis had a 72% 2-year survival rate.

## Abstract

This retrospective observational single-centre analysis included 31 patients who underwent transcatheter aortic valve implantation (TAVI) between 2016 and 2024 and subsequent open-heart surgery between 2019 and 2024. They were admitted from infectious disease departments or cardiology clinics and accounted for 0.7% of heart operations performed in 2024. The incidence of definite endocarditis was 0.5% (17/3226) of all TAVI procedures performed during this period. Of the 17 patients, 9 (53%) with definite endocarditis underwent aortic valve replacement, with 1 early death (11%) from bowel ischaemia and liver failure. The 2-year postoperative survival for definite endocarditis was 76%. Open-heart surgery was contraindicated in all 8 patients with definite endocarditis due to severe comorbidities and frailty. These patients died within 2 years of the infection or due to heart failure. Furthermore, 10 patients classified as having endocarditis after TAVI were medically treated and had a 2-year survival rate of 72%. The survival rate was 87% at 2 years after open-heart surgery for non-infectious indications performed up to 5 years after TAVI in 22 patients. In conclusion, heart surgery can be curative in selected patients with definite endocarditis after TAVI and lifesaving after rare TAVI complications.

The first transcatheter aortic valve implant (TAVI) in Sweden was performed in 2008 at the Karolinska University Hospital in Stockholm.