The following is a summary of “Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement,” published in the January 2024 issue of Cardiology by Ried et al.

Among complications following aortic valve replacement, prosthetic valve endocarditis (PVE) presents the most unfavorable prognosis.

Researchers conducted a retrospective study to enhance understanding of the varying pathological and therapeutic aspects of PVE post-surgical aortic valve replacement (SAVR) compared to transcatheter aortic valve replacement (TAVI).

The results showed that the incidence of PVE did not differ between SAVR (4.9/100 patient-years) and TAVI (2.4/100 patient-years) (P=0.49) despite TAVI patients being older (mean 80 vs 67 years) and having more comorbidities (STS score mean 5.9 vs 1.6) (P<0.001). TAVI prostheses with polymers exhibited a 4.3-fold higher risk of PVE than those without polymers (HR 4.3; P= 0.004). Staphylococci and Enterococci were the most common pathogens (P>0.05). Propensity-score matching analysis indicated that the type of aortic valve replacement did not affect post-procedural PVE development (P=0.997). One-year survival was higher in TAVI-PVE patients treated with antibiotics only compared to those undergoing additional surgical therapy (90.9% vs 33.3%; P=0.005). In SAVR-PVE patients, both therapies showed comparable survival rates (P=0.861). SAVR-PVE patients who did not undergo surgery, despite ESC guideline recommendations, exhibited significantly poorer one-year survival (P=0.004).

Investigators concluded that TAVI patients with PVE may often be treated solely with antibiotics due to the absence of a polymeric suture ring, unlike SAVR-PVE patients.

Source: link.springer.com/article/10.1007/s00392-023-02356-4