Key result
Cardiac surgery for post-TAVR endocarditis shows ~53% 1-year survival in observational cohort.
Why the study?
With the expansion of TAVR into intermediate and low risk populations, the number of infective endocarditis cases following TAVR is expected to rise, necessitating evaluation of surgical treatment outcomes.
Observational (n=69)
Yes
Cardiac surgery for infective endocarditis following TAVR is associated with acceptable morbidity and mortality rates, supporting early surgical intervention in these patients.
Modest late survival after surgery for post-TAVR endocarditis warrants cautious patient selection; leaves open optimal timing and indications for prospective study.
OBJECTIVES: With the expansion of transcatheter aortic valve replacement (TAVR) into intermediate and low risk, the number of TAVR procedures is bound to rise and along with it the number of cases of infective endocarditis following TAVR (TIE). The aim of this study was to review a multicentre experience of patients undergoing surgical intervention for TIE and to analyse the underlying indications and operative results. METHODS: We retrospectively identified and analysed 69 patients who underwent cardiac surgery due to TIE at 9 cardiac surgical departments across Germany. The primary outcome was operative mortality, 6-month and 1-year survival. RESULTS: Median age was 78 years (72-81) and 48(69.6%) were male. The median time to surgical aortic valve replacement was 14 months (5-24) after TAVR, with 32 patients (46.4%) being diagnosed with early TIE. Cardiac reoperations were performed in 17% of patients and 33% underwent concomitant mitral valve surgery. The main causative organisms were: Enterococcus faecalis (31.9%), coagulase-negative Staphylococcus spp. (26.1%), Methicillin-sensitive Staphylococcus aureus (15.9%) and viridians group streptococci (14.5%). Extracorporeal life support was required in 2 patients (2.9%) for a median duration of 3 days. Postoperative adverse cerebrovascular events were observed in 13 patients (18.9%). Postoperatively, 9 patients (13.0%) required a pacemaker and 33 patients (47.8%) needed temporary renal replacement therapy. Survival to discharge was 88.4% and survival at 6 months and 1 year was found to be 68% and 53%, respectively. CONCLUSIONS: Our results suggest that TIE can be treated according to the guidelines for prosthetic valve endocarditis, namely with early surgery. Surgery for TIE is associated with acceptable morbidity and mortality rates. Surgery should be discussed liberally as a treatment option in patients with TIE by the 'endocarditis team' in referral centres.
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Saha et al. (2022) conducted an observational in Infective endocarditis following transcatheter aortic valve replacement (TIE) (n=69). Cardiac surgery was evaluated on Operative mortality, 6-month and 1-year survival. Cardiac surgery for infective endocarditis following TAVR was associated with a survival to discharge of 88.4%, and survival rates of 68% at 6 months and 53% at 1 year.
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