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Infective endocarditis and cardiac events after transcatheter vs surgical aortic valve replacement - A nationwide cohort study #MMPMID40784589
Kutz A; Purtak M; Laager R; Stortecky S; Conen A
Int J Infect Dis 2025[Aug]; ä (ä): 108011 PMID40784589show ga
OBJECTIVES: To compare rates of infective endocarditis (IE) and major adverse cardiac events (MACE) in patients with TAVI, bioprosthetic (bio), and mechanical (mech) SAVR. METHODS: Population-based cohort study of inpatient adults undergoing TAVI, bioSAVR or mechSAVR for aortic valve stenosis between 2012 and 2021 in Switzerland. In two pairwise 1:1 propensity-score matched cohorts (TAVI versus bioSAVR and bioSAVR versus mechSAVR) we analysed the primary outcome of the incidence of IE and secondary outcomes including MACE. RESULTS: Among 18,253 patients undergoing aortic valve replacement (mean age 76.6+/-10.3 years, 43.8% female), the incidence rate (IR) of IE was highest in the first three months after the intervention (TAVI, bioSAVR, mechSAVR: 23.61, 18.87, 16.65 per 1,000 person-years, respectively). After matching, the rate of IE was higher in patients undergoing TAVI versus bioSAVR (n=2,329 pairs, HR 1.56 [95% CI, 1.12-2.18]; incidence rate difference [IRD] 3.84 [95% CI,1.29-6.39] per 1,000 person-years), and higher in bioSAVR versus mechSAVR (n=773, HR 2.27 [1.24-4.15]; IRD 4.57 [1.29-7.85] per 1,000 person-years). The HRs for MACE were 2.10 [1.90-2.33] and 2.09 [1.58-2.77], respectively. CONCLUSIONS: For patients undergoing aortic valve replacement for native aortic valve stenosis, TAVI was associated with higher rates of IE than bioSAVR, as was bioSAVR when compared with mechSAVR.