Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

J Am Coll Cardiol. 2022 Mar 1;79(8):772-785. doi: 10.1016/j.jacc.2021.11.056.


Background: The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain.

Objectives: The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB).

Methods: Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry.

Results: Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock.

Conclusions: In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications.

Keywords: TAVI; antibiotics; cardiac surgery; infective endocarditis; outcome.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Cardiac Surgical Procedures
  • Combined Modality Therapy
  • Endocarditis, Bacterial / drug therapy*
  • Endocarditis, Bacterial / etiology
  • Endocarditis, Bacterial / surgery*
  • Female
  • Humans
  • Male
  • Prosthesis-Related Infections / drug therapy*
  • Prosthesis-Related Infections / etiology
  • Prosthesis-Related Infections / surgery*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / surgery*
  • Transcatheter Aortic Valve Replacement* / adverse effects


  • Anti-Bacterial Agents