Researchers conducted a retrospective study using a US electronic health record database to examine 373,946 aortic valve replacement procedures performed between January 1, 2018, and December 31, 2025. Of these, 262,465 were TAVR procedures and 111,481 were SAVR procedures.
Endocarditis cases were identified using ICD-10 codes, with noninfectious causes excluded. Researchers classified infections as early when they occurred within three months of the procedure and late when they developed after three months.
Overall, 3.44% of patients developed infective endocarditis. The incidence was 2.63% among TAVR recipients, compared with 5.37% among SAVR recipients (p<0.001). This represented a 51% lower rate of IE following the transcatheter procedure.
Early IE incidence showed an upward trend over the study period in both groups, with p=0.027 for TAVR and p=0.028 for SAVR. Late IE incidence initially increased in both cohorts but declined sharply after 2023, a trend researchers considered likely to reflect the shorter period of available follow-up.
Staphylococcus aureus was the most common bloodstream pathogen in both groups, although it was identified less frequently after TAVR than after SAVR. The organism accounted for 29.7% of cases in the TAVR group and 36.1% in the SAVR group (OR: 0.75; 95% CI: 0.68 to 0.82).
Enterococcus faecalis was the second most frequently identified organism, accounting for 20.3% of cases after TAVR and 15.7% after SAVR. Women represented 41.3% of IE cases among TAVR recipients, compared with 28.0% among SAVR recipients (p<0.001).
The study also identified differences in the age and socioeconomic profiles of patients undergoing the two procedures. TAVR recipients were older, with 40.3% aged 80 years or older, compared with 5.9% of SAVR recipients. They were also less socioeconomically vulnerable.
Among patients who did not develop infective endocarditis, 12-month mortality was higher after TAVR than after SAVR, at 7.15% and 5.05%, respectively (p<0.001). However, among patients who developed IE, mortality did not differ significantly between the groups. The reported rates were 7.98% after TAVR and 8.71% after SAVR (p=0.134).
The older age of patients undergoing TAVR may help explain the higher one-year mortality observed in that group, according to the study's findings. Once infective endocarditis developed, the difference in mortality between the two procedures was no longer statistically significant.
Although the analysis found a substantially lower incidence of infective endocarditis after TAVR, the infection remained a risk following both transcatheter and surgical valve replacement. The findings underscore the importance of effective infection prevention measures regardless of the procedure used.
About The Author
Comment List