Infective endocarditis following transcatheter valvular interventions (transcatheter aortic valve implantation and transcatheter edge-to-edge repair)

Infective endocarditis (IE) following transcatheter valvular interventions, including transcatheter aortic valve implantation and transcatheter edge-to-edge repair, is an uncommon but life-threatening complication associated with major diagnostic and therapeutic challenges. As indications for structural interventions continue to expand, the burden of device-related IE is expected to increase. This expert opinion, jointly developed by the Association of Valvular Heart Disease and the Association of Cardiovascular Intervention of the Polish Cardiac Society, summarizes contemporary evidence regarding the epidemiology, clinical presentation, diagnosis, treatment, and prevention of transcatheter valve-related IE. Transcatheter aortic valve implantation-related IE occurs at an estimated incidence of 0.3-2.0 per 100 person-years and is associated with high in-hospital and long-term mortality, whereas transcatheter edge-to-edge repair-related IE is less frequent but similarly associated with poor outcomes. Clinical presentation is frequently atypical, particularly in elderly and in patients with multimorbidity, resulting in delayed diagnosis. Echocardiography remains the first-line imaging modality but is often limited by prosthesis-related artifacts. Multimodality imaging, particularly electrocardiography-gated cardiac computed tomography and in selected cases positron emission tomography, substantially improves diagnostic accuracy and detection, especially of perivalvular complications. Management relies on prolonged pathogen-directed intravenous antibiotic therapy, but surgical intervention should be considered in all patients, with a significant indication for surgery in patients with uncontrolled infection, heart failure, embolic complications, or extensive tissue destruction. Preventive measures, including maintaining strict periprocedural asepsis and targeted antibiotic prophylaxis, remain essential. IE after transcatheter valvular interventions therefore represents a rare but devastating complication requiring high clinical vigilance, multidisciplinary management, and individualized treatment strategies to improve outcomes.