Infective endocarditis after transcatheter aortic valve implantation. A comparison with endocarditis occurring in surgical aortic prosthesis and native aortic valve patients

Abstract

Infective endocarditis is rare but serious. Epidemiology is well known in standard population and surgical valve patients (Pts). The recent development of Transcatheter Aortic Valve Implantation (TAVI) raise new questions about endocarditis in this population. To assess the epidemiology and mortality of endocarditis in TAVI Pts and to compare the results to surgical valve owners and native patients. We included all patients presenting with endocarditis after TAVI between 2010 and 2018 hospitalized in our institution. We compared these patients to those discussed within the “endocarditis team staff” and presenting with endocarditis located on surgical aortic prosthetic valve or on native aortic valve. A total of 34 TAVI Pts were included, and compared to a population of 45 surgical aortic prosthetic valve and 68 native Pts. TAVI Pts were older (83.1 ± 1.1 yrs, vs 73.3 ± 1.7 and 66.0 ± 1.7, respectively; P < 0.001) and had a higher Charlson score (6.2 ± 0.4, vs 5.6 ± 0.4 and 4.1 ± 0.3; P < 0.001). TAVI Pts underwent more frequently invasive procedures during the 6 months prior to the diagnosis of endocarditis (38.2%, vs 11.4 and 8,8%; P < 0.001). They had less occurrence of a new valvular murmur (0%, vs 28.9 and 33.8%; P = 0.001) and less heart failure symptoms (26.5%, vs 28.9 and 33.8%; P = 0.007). Clinical complications were similar between the 3 groups and mortality is comparable at 1 year (29.2%, vs 36.4 and 29.7% P = 0.730). However, TAVI Pts were more frequently re-hospitalized at 1 year (41.2% vs 26.7% and 16.2%, P = 0.02) and were treated less invasively (surgery or pacemaker extraction in 14.7% vs 35.6% and 42.6%, P = 0.019). Only one TAVI Pt needed surgical aortic valve replacement. TAVI patients affected by infective endocarditis, despite more comorbidities, have the same mortality at 1 year compared to prosthetic valve owners and patients with aortic endocarditis on native valve but are more often rehospitalized.