Emerging insights into infective endocarditis in the era of transcatheter aortic valve implantation

With the rapid expansion of transcatheter aortic valve implantation (TAVI), infective endocarditis (IE) involving transcatheter prostheses has emerged as a major clinical challenge associated with high morbidity and mortality. Although the overall incidence of TAVI-associated IE remains relatively low, outcomes are poor, particularly in elderly and frail patients with multiple comorbidities. Importantly, TAVI-associated IE differs from surgical prosthetic valve endocarditis in several aspects, including patient profile, microbiological characteristics, imaging findings, and therapeutic management. This contemporary review summarizes recent evidence regarding the epidemiology, microbiology, multimodality imaging, management strategies, and prognosis of IE following TAVI. Particular emphasis is placed on the prominent role of enterococci, the limitations of conventional echocardiography, and the growing importance of multimodality imaging techniques such as cardiac CT and [¹ 8 F]-FDG PET/CT for diagnosis and detection of perivalvular complications. Current evidence regarding surgical versus conservative management remains limited and strongly influenced by patient selection and operative risk, making individualized Heart Team decision-making essential. Despite advances in transcatheter therapies and imaging modalities, TAVI-associated IE continues to carry very high short- and long-term mortality. Improved preventive strategies, earlier diagnosis, optimized multimodality imaging algorithms, and better selection of patients for surgical intervention are needed to improve outcomes in this high-risk population.