Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis.

Abstract

Infective endocarditis following transcatheter aortic valve replacement (TAVR) is an emerging problem, with a high rate of morbidity and mortality. However, little is known about the burden of disease, and data on infective endocarditis incidence are scarce. This study aimed to evaluate the incidence of infective endocarditis in TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2019. Included studies were prospective or retrospective cohort studies that reported the event rate of infective endocarditis in patients who underwent TAVR. Data from each study were combined using the random-effects method to calculate pooled incidence with 95% confidence intervals (CIs). A total of 30 studies consisting of 73 780 patients undergoing TAVR were included in this meta-analysis. Overall, the pooled estimated incidence of infective endocarditis following TAVR was 7 in 1000 patients (95% CI: 0.5-1%). For early infective endocarditis, the pooled estimated incidence was 8 per 1000 patients (95% CI: 0.5-1.1%). For late infective endocarditis, the pooled estimated incidence was 2 in 1000 patients (95% CI: 0.1-0.4%). Significantly, the overall pooled infective endocarditis mortality rate was 39% (95% CI: 28.7-49.4%). The current study demonstrates the incidence of overall, early, and late infective endocarditis following TAVR, ranging from 2 to 8 per 1000 patients. Although it remains a rare event, infective endocarditis following TAVR is associated with high mortality.