Key result
Transcatheter aortic valve replacement resulted in a similar risk of infective endocarditis compared to surgical aortic valve replacement (pooled log RR -0.006, p=0.948).
Why the study?
With the expanding use of TAVR in younger, lower-risk patients, it is critical to evaluate its risk of infective endocarditis compared with SAVR.
Does transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) alter the incidence of infective endocarditis in adult patients?
Meta-Analysis (n=118,443)
Yes
Does transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) alter the incidence of infective endocarditis in adult patients?
Effect estimate: log RR -0.006 (95% CI -0.198, 0.185)
p-value: p=0.948
TAVR and SAVR carry a comparable risk of infective endocarditis, but the high associated mortality highlights the need for personalized risk assessment, particularly in patients with chronic kidney disease, pacemakers, or valve-in-valve procedures.
Comparable IE rates after TAVR and SAVR support individualized valve selection; reinforces consensus but high heterogeneity leaves open need for standardized studies.
Aortic valve replacement is an effective intervention for valvular heart disease. However, it carries a rare but serious risk of infective endocarditis (IE). With the expanding use of transcatheter aortic valve replacement (TAVR) in younger, lower-risk patients, it is critical to evaluate its IE risk compared with that of surgical aortic valve replacement (SAVR). We hypothesized that TAVR and SAVR have comparable IE incidence rates but distinct risk profiles influenced by procedural and patient-specific factors. A total of 17 articles were included in our study. Seventeen studies were included in the qualitative synthesis, and seven studies (118,443 patients) were included in the quantitative analysis. Studies focusing on the incidence of IE after TAVR and SAVR were included. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered. There was no significant difference in IE risk between TAVR and SAVR (pooled log risk ratio (RR): -0.006, 95% CI (-0.198, 0.185), p = 0.948), although risk estimates varied widely (-1.14 to -1.57), with high heterogeneity (I² = 96%). Major risk factors included valve-in-valve procedures (RR = 2.88), pacemaker implantation (hazard ratio (HR) = 1.91), and chronic kidney disease (HR = 2.08). In-hospital mortality was high (TAVR: 34.4%, SAVR: 31.8%), with over 60% mortality at five years. TAVR and SAVR have similar rates of IE, but differences in data highlight the need for consistent reporting and personalized risk assessment. Better monitoring, especially for pacemakers or patients with kidney disease, could help improve outcomes. Since prosthetic valve infections have high death rates, guidelines for removing infected TAVR valves may need to be reconsidered.
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Chaudhri et al. (2025) conducted a meta-analysis in Valvular heart disease requiring aortic valve replacement (n=118,443). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Incidence of infective endocarditis (log RR -0.006, 95% CI -0.198, 0.185, p=0.948). Transcatheter aortic valve replacement resulted in a similar risk of infective endocarditis compared to surgical aortic valve replacement (pooled log RR -0.006, p=0.948).
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