Infective endocarditis and cardiac events after transcatheter vs surgical aortic valve replacement - A nationwide cohort study

To compare rates of infective endocarditis (IE) and major adverse cardiac events (MACE) in patients with TAVI, bioprosthetic (bio), and mechanical (mech) SAVR. 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. 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. 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.