Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement

Abstract

Background and aimsProsthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI).MethodsAll patients who had undergone primary isolated SAVR (n = 3447) or TAVI (n = 2269) at our Centre between 01/2012 and 12/2018 were analysed. Diagnosis of PVE was based on Duke criteria modified in 2015. Incidence, risk factors, pathogens, impact of complications or therapy on mortality were analysed and compared between SAVR- and TAVI-PVE.ResultsPVE incidence did not differ significantly after SAVR with 4.9/100 patient-years and TAVI with 2.4/100 patient-years (p = 0.49), although TAVI patients were older (mean 80 vs. 67 years) and had more comorbidities (STS score mean 5.9 vs. 1.6) (p < 0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than without polymer (HR 4.3; p = 0.004). Most common pathogens were staphylococci and enterococci (p > 0.05). Propensity-score matching analysis showed that the type of aortic valve replacement had no effect on the development of post-procedural PVE (p = 0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to additional surgical therapy (90.9% vs. 33.3%; p = 0.005). In SAVR-PVE patients, both therapies were comparable in terms of survival (p = 0.861). However, SAVR-PVE patients who were not operated, despite ESC-guideline recommendation, had significantly poorer one-year survival (p = 0.004).ConclusionTAVI patients did not have a significantly higher risk to develop PVE. Our data suggest that TAVI-PVE patients in contrast to SAVR-PVE patients can more often be treated with antibiotics only, presumably due to the lack of a polymeric suture ring.Graphical abstractKey question:What are the differences between SAVR- and TAVI-PVE?Are the current ESC guidelines for the treatment of SAVR-PVE also applicable to TAVI-PVE?Key finding:No significantly different PVE incidences after SAVR and TAVISignificantly better one-year survival and significantly longer survival in TAVI-PVE treated with antibiotics only compared with additional surgical therapyHigher risk to develop PVE after TAVI in patients carrying prostheses containing polymer particlesTake-home messageTAVI-PVE can often be treated successfully with antibiotics-only, even if surgery would have been indicated according to current guidelines.SAVR-PVE patients benefit from surgical therapy, so guideline-compliant surgical indication should be made promptly and performed immediately