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. 2022 Jun 14;11(12):3418.
doi: 10.3390/jcm11123418.

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Shekhar Saha  1   2 , Ahmad Ali  1   2 , Philipp Schnackenburg  1   2 , Konstanze Maria Horke  1   2 , Andreas Oberbach  1   2   3 , Nadine Schlichting  3   4 , Sebastian Sadoni  1   2 , Konstantinos Rizas  5 , Daniel Braun  5 , Maximilian Luehr  1   6 , Erik Bagaev  1   7 , Christian Hagl  1   2 , Dominik Joskowiak  1   2
Affiliations

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Shekhar Saha et al. J Clin Med. .

Abstract

Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6-62.0) v/s 45.4 (32.6-58.1), p = 0.207) and STS-PROM (1.8 (1.6-2.1) v/s 1.9 (1.4-2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

Keywords: infective endocarditis; prosthetic valve endocarditis; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Case load of infective endocarditis from January 2013 to December 2020. NVE, native valve endocarditis; PVE, prosthetic valve endocarditis; SAVR–PVE, prosthetic valve endocarditis following surgical aortic valve replacement; TIE, prosthetic valve endocarditis following transcatheter aortic valve replacement.
Figure 2
Figure 2
Temporal distribution of aortic prosthetic valve endocarditis with the distribution of SAVR–PVE and TIE. (Data are expressed as percentages.) SAVR–PVE, prosthetic valve endocarditis following surgical aortic valve replacement; TIE, prosthetic valve endocarditis following transcatheter aortic valve replacement.
Figure 3
Figure 3
Kaplan–Meier survival curves of the SAVR–PVE group compared with the TIE group, with the number of patients at risk in tabular form. SAVR–PVE, prosthetic valve endocarditis following surgical aortic valve replacement; TIE, prosthetic valve endocarditis following transcatheter aortic valve replacement.
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