Clinical Profiles and Outcomes of Prosthesis-Specific Infective Endocarditis Subsequent to Transcatheter Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Abstract

Prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement using either a transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). This study aims to review the profiles and outcomes of PVE after surgical versus transcatheter aortic valve replacement. Electronic searches were performed on Scopus, EMBASE, and PubMed to retrieve related articles. To be included, study designs had to be randomized controlled trials (RCT) or observational cohort studies (in English) with PVE patients that compared differences based on TAVI or SAVR. This review included data for 13,221 patients with PVE diagnoses. Of those, 2,109 patients had an initial SAVR, and 11,112 patients had an initial TAVI. There was no difference in the incidence of PVE in patients who had initial TAVI versus SAVR (1.05% versus 1.01% per person-year, p=0.98). However, the onset of early PVE was more frequently observed in the TAVI group (risk ratio (RR): 1.54, 95% confidence interval (CI) [1.14, 2.08], p=0.005). Patients in the TAVI group had a lower indication for surgery to treat PVE when compared to SAVR (RR: 0.55, 95%CI [0.44, 0.69], p<0.001). Staphylococcus aureus was more likely to be the source of PVE in patients who had previous TAVI (RR: 1.34, 95%CI [1.17, 1.54], p<0.001). Also, Enterococcus faecalis was more frequently observed as a cause of PVE in the TAVI group (RR: 1.49, 95%CI [1.21, 1.82], p<0.001). Patients who underwent SAVR and TAVI had similar incidences of PVE. However, patients who underwent SAVR had a greater indication for surgery to treat PVE, while those who underwent TAVI had higher comorbidities, a higher likelihood of early PVE, and a trend towards higher one-year mortality.