Infective Endocarditis after Transcatheter Aortic Valve Replacement—Is Surgery an Option?

Background: Infective endocarditis of prosthetic valves is a severe condition with high mortality, especially when surgical explantation of infected transcatheter heart valves (THV) is required. Little is known about factors influencing mortality and the long-term outcomes of surviving patients. This study aimed to identify parameters associated with mortality in transcatheter aortic valve replacement (TAVR) patients with infective endocarditis requiring THV explantation and analyze their long-term outcomes post-discharge.

Methods: A case-control study was conducted involving TAVR patients who underwent surgical THV explantation for infective endocarditis at our center between February 2008 and December 2023. Fifteen cases of periprocedural death were compared with 35 successfully discharged patients. Data on baseline, procedural, and clinical outcomes were retrieved from the institution’s database.

Results: No significant differences were found between the groups for age, sex, height, weight, kidney function, history of cerebrovascular disease, COPD, diabetes mellitus, or peripheral artery disease. The cases group had significantly lower left ventricular function and higher logistic EuroScore and STS-Score before AVR. There were no significant differences in causative microorganisms, cross-clamp time, or concomitant surgeries between groups. Postoperatively, no differences were found in the need for new pacemaker implantation, rethoracotomy, stroke, or median ICU/hospital stay. Dialysis was more frequent in the cases group (44% vs. 25.7%). Follow-up time was 294 days (IQR: 1 day–3,802 days). Overall mortality was 79.8% at 30 days and 67.4% at 1 year. Of the control group, six patients were discharged to rehabilitation or other hospitals. At time of enrollment, all were alive, 29 went home, with four deaths (one early, three late).

Conclusion: Mortality was high at 20.2% at 30 days and 33.6% at 1 year. Patients with low STS PROM had better survival compared with those with intermediate or high operative risk. Early mortality was associated with significantly higher EuroScore II and STS PROM, and higher rates of postoperative renal failure. Most surviving patients recovered well and returned to independent living.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025