Infective Endocarditis After TAVR—Surgical Challenges and Outcomes

TL;DR

Surgical treatment for heart valve infection after a TAVR procedure has high early risks but better long-term outcomes for survivors.

Contribution

Identifies preoperative risk scores and dialysis as predictors of mortality in IE after TAVR treated with SAVR.

Findings

Early mortality after SAVR for IE after TAVR is 18.1% at 30 days and 32.6% at 1 year.

Higher preoperative risk scores and postoperative dialysis are linked to perioperative death.

Most hospital survivors regain independent living with 67.4% survival at 1 year.

Abstract

Background: Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a severe complication. Surgical explantation of infected transcatheter heart valves (THV) is technically demanding and associated with high mortality. Data on risk factors for perioperative death and long-term outcomes remain limited. Aim: To identify predictors of mortality in patients undergoing surgical aortic valve replacement (SAVR) for IE after TAVR. Methods: We conducted a case–control study of patients treated with SAVR for IE after TAVR at our center between February 2008 and December 2023. Fifteen patients who died in hospital (cases) were compared with 35 perioperative survivors (controls). Hospital survivors were followed for long-term outcomes. Results: Age, sex, comorbidities (kidney disease, cerebrovascular disease, COPD, diabetes, peripheral artery disease), and anthropometrics were similar between groups. Cases had significantly lower left ventricular function and higher logistic EuroSCORE and STS-PROM before surgery. Causative microorganisms, cross-clamp time, and concomitant procedures did not differ. Postoperative pacemaker implantation, rethoracotomy, stroke, and ICU or hospital stay were comparable, while dialysis was more frequent in cases (44% vs. 25.7%). Median follow-up was 294 days (range 1–3802). Survival was 79.8% at 30 days and 67.4% at 1 year. Of 35 hospital survivors, 29 were discharged home, 6 to rehabilitation/other hospitals; 31 remain alive (1 early, 3 late deaths). Conclusions: SAVR for IE after TAVR carries high early mortality (18.1% at 30 days; 32.6% at 1 year). Higher preoperative risk scores and postoperative dialysis were associated with perioperative death. Long-term survival among hospital survivors is favorable, with most patients regaining independent living.

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