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. 2025 Apr 10;111(9):412-420.
doi: 10.1136/heartjnl-2024-324803.

Bacteraemia after transcatheter aortic valve implantation: a nationwide cohort study

Katra Hadji-Turdeghal  1 , Jeppe K Petersen  2 , Peter Laursen Graversen  2 , Jawad Haider Butt  2   3 , Jarl Emanuel Strange  2   4 , Nikolaj Ihlemann  5 , Jordi Sanchez Dahl  6 , Jonas Agerlund Povlsen  7 , Marianne Voldstedlund  8 , Christian Juhl Terkelsen  7 , Christian H Møller  9 , Philip Freeman  10 , Henrik Nissen  6 , Ole De Backer  2 , Lars Koeber  2 , Lauge Østergaard  2 , Emil Loldrup Fosbøl  2
Affiliations

Bacteraemia after transcatheter aortic valve implantation: a nationwide cohort study

Katra Hadji-Turdeghal et al. Heart. .

Abstract

Background: Bacteraemia and infective endocarditis (IE) are rare but severe complications of transcatheter aortic valve implantation (TAVI). Limited data exist on the incidence and microbiological profile of early bacteraemia in this population. This study aimed to evaluate the 6-month incidence of bacteraemia, IE and associated mortality following TAVI.

Methods: Using Danish nationwide registries, all patients who underwent TAVI from 2012 to 2021 were identified and matched 1:1 by age, sex and index year with patients who underwent elective coronary angiography (CAG). Outcomes were assessed with cumulative incidence functions and adjusted HRs.

Results: Among 5990 patients with first-time TAVI (57% male, mean age 80 years, SD 6.9), bacteraemia occurred in 4.2% within 6 months, compared with 2.6% in the CAG group (adjusted HR 1.57, 95% CI 1.26 to 1.96). Common pathogens post-TAVI included Streptococci (20%), Coagulase-negative staphylococci (19%) and Enterococci (18%), differing from the CAG group, where Coagulase-negative staphylococci (22%) and Staphylococcus aureus (16%) predominated. IE developed in 1.1% of patients with TAVI versus 0.1% of patients with CAG (adjusted HR 20.01, 95% CI 5.97 to 67.48).

Conclusion: Bacteraemia and IE rates are substantially elevated within 6 months following TAVI compared with elective CAG. The bacterial profile post-TAVI suggests that current prophylactic antibiotic regimens may not provide adequate coverage.

Keywords: aortic valve stenosis; endocarditis; epidemiology; transcatheter aortic valve replacement.

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Conflict of interest statement

Competing interests: JHB: reports advisory board honoraria from AstraZeneca and Bayer; consultant honoraria from Novartis and AstraZeneca; travel grants from AstraZeneca. CJT: research grants from Edward, Meril, Terumo. Proctor fee from Edwards and Meril. Research grants from The Danish Heart Foundation. Independent research grant related to valvular heart disease unrelated to this manuscript. LK: has received lecture fees from AstraZeneca, Bayer, Boehringer, Novartis and Novo, unrelated to this manuscript. LØ: an independent research grant from the Novo Nordisk Foundation for the study of mitral regurgitation, unrelated to this manuscript. ELF: independent research grants from the Novo Nordisk Foundation and the Danish Heart Association, related to valvular heart disease and endocarditis, unrelated to this manuscript. KH-T, JKP, PLG, JES, NI, JSD, JAP, MV, CHM, PF, HN, ODB: none.

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