Infective endocarditis on percutaneous aortic valve prosthesis: incidence, characteristics and comparison with endocarditis on surgically implanted aortic bioprostheses

Abstract Background Transcatheter aortic valve replacement (TAVR) has become a first-line therapeutic measure in patients with severe aortic stenosis, especially in selected patients who present a very high surgical risk; nevertheless, this technique is becoming increasingly widespread even among patients with a lower surgical risk. Infective endocarditis (IE) is an infrequent but very serious complication in patients undergoing TAVR implantation. The aforementioned generalization of this technique means that more and more patients are at risk of developing this complication which, in addition, seems to have some particularities with respect to endocarditis in other patients. Purpose The aim of our study was to analyze the incidence, clinical characteristics and mortality of IE in patients with TAVR, comparing them with IE in patients with surgically implanted prostheses (SAVR). Methods Observational, single-center, prospective cohort study including all cases of IE diagnosed and prospectively followed up in our center from 2008 to 2022, according to Duke or ESC diagnostic criteria, depending on the era. We identified cases of IE in patients with TAVR in this period and compared their characteristics with endocarditis in patients with surgical aortic prostheses. Results In our center 10 cases of IE have been diagnosed in patients with TAVR. Since 2008 this procedure has been successfully performed in 778 patients, which gives an incidence of 1.29% compared to 1.68% of its surgical counterpart with a total of 24 cases of IE. The clinical characteristics of these patients are shown in the table. With the exception of mean age (p= 0.006), there were no significant differences between the two groups. In approximately half of the cases the diagnosis was made early after valve replacement (<1 year after replacement). With respect to the causative microorganisms, the most prevalent agent was enterococci, followed by coagulase-negative staphylococci and staphylococcus aureus; in 17% of patients with SAVR the causative agent was not identified. The clinical evolution was similar in both groups, with a high proportion of severe complications and 50% of cardiac complications in the TAVR group. Half of the patients had a surgical indication at diagnosis, but only 50% underwent surgery. There were also no differences in mortality, which, nevertheless, was high, around 30%. Conclusions Despite the differences in mean age, no significant differences were found between the two groups. IE is an infrequent but serious complication in patients with prosthetic valves, with a high rate of serious complications and mortality regardless of its management.Baseline characteristics of patients