Prosthetic valve endocarditis after transcatheter or surgical aortic valve replacement with a bioprosthesis: results from the FinnValve Registry.

ABSTRACT

AIMS: The aim of this study was to compare the risk of prosthetic valve endocarditis (PVE) in patients with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). METHODS AND RESULTS: The FinnValve registry included data from 6,463 consecutive patients who underwent TAVR (n=2,130) or SAVR (n=4,333) with a bioprosthesis from 2008 to 2017. PVE was defined according to the modified Duke criteria. In this study, the incidence of PVE was 3.4/1,000 person-years after TAVR, and 2.9/1,000 person-years after SAVR. In competing risk analysis there was no significant difference in the risk of PVE between patients with TAVR and SAVR over an eight-year observational period. Male gender (HR 1.73, 95% CI 1.04-2.89) and deep sternal wound infection or vascular access-site infection (HR 5.45, 95% CI 2.24-13.2) were positively associated with PVE, but not type of procedure (HR 1.09, 95% CI 0.59-2.01) in multivariate analysis. The mortality rate was 37.7% at one month and increased to 52.5% at one year. Surgical treatment was independently associated with decreased in-hospital mortality (HR 0.34, 95% CI 0.21-0.61). CONCLUSIONS: PVE is rare, and its risk is similar after TAVR and SAVR. ClinicalTrials.gov Identifier NCT03385915. https//clinicaltrials.gov/ct2/show/NCT03385915.