Incidence and outcomes of infective endocarditis after transcatheter versus surgical aortic valve replacement: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

AN Zhijing ² , WEI Zhili ¹ ,  LI Yuanmin ²

1. The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding?author：

LI Yuanmin, Email: ldyylym@163.com

Keywords：

Transcatheter aortic valve replacement; surgical aortic valve replacement; infective endocarditis; pathogen; reoperation rate; mortality rate; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202512103

Video：

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Objective To systematically compare the incidence, microbiological profile, and outcomes of infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). Methods A systematic literature search was conducted in the CNKI, Wanfang, VIP, SinoMed, PubMed, the Cochrane Library, Embase, and Web of Science databases for relevant studies published from their inception to August 2025. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The quality of cohort studies was evaluated using the modified Newcastle-Ottawa Scale (NOS), and randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias tool 2 (RoB 2). A meta-analysis was performed using Stata 19.0. Results A total of 12 cohort studies and 1 RCT, encompassing over 200 000 patients, were included. The modified NOS scores for all cohort studies were ≥7 points, and the RCT was rated as having a low overall risk of bias. The overall incidence of IE was significantly lower after TAVR than that after SAVR [RR=0.73, 95%CI (0.59, 0.90), P<0.01]. However, early IE (within 12 months) occurred more frequently following TAVR, though the difference was not statistically significant [RR=1.23, 95%CI (0.87, 1.75), P=0.24]. Reoperation for IE was markedly less common in the TAVR group [RR=0.31, 95%CI (0.20, 0.47), P<0.01]. There were no significant differences in in-hospital mortality or 1-year mortality between the two groups. Regarding the microbiological profile, no significant differences were observed in the distribution of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus spp., and Enterococcus spp. (P>0.01). Conclusion TAVR is associated with a lower overall risk of IE but a higher risk of early IE compared to SAVR. Although reoperation is less common in TAVR patients, mortality rates are comparable. The microbiological etiology is consistent between procedures.

1.	Li M, Kim JB, Sastry BKS, et al. Infective endocarditis. Lancet, 2024, 404(10450): 377-392.
2.	Ando T, Ashraf S, Villablanca PA, et al. Meta-analysis comparing the incidence of infective endocarditis following transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol, 2019, 123(5): 827-832.
3.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
4.	Barreiro L, Roldán á, Aguayo N, et al. Infectious endocarditis on percutaneous aortic valve prosthesis: comparison with surgical bioprostheses. REC Interv Cardiol, 2025, 7(2): 75-81.
5.	Calderón-Parra J, de Villarreal-Soto JE, Oteo-Domínguez JF, et al. Risk of infective endocarditis associated with transcatheter aortic valve implantation versus surgical aortic valve replacement: a propensity score-based analysis. J Clin Med, 2023, 12(2): 586.
6.	Fauchier L, Bisson A, Herbert J, et al. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect, 2020, 26(10): 1368-1374.
7.	Jerónimo A, Olmos C, Zulet P, et al. Clinical characteristics and outcomes of aortic prosthetic valve endocarditis: comparison between transcatheter and surgical bioprostheses. Infection, 2024, 52(6): 2425-2434.
8.	Kolte D, Goldsweig A, Kennedy KF, et al. Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States. Am J Cardiol, 2018, 122(12): 2112-2119.
9.	Moriyama N, Laakso T, Biancari F, et al. Prosthetic valve endocarditis after transcatheter or surgical aortic valve replacement with a bioprosthesis: results from the FinnValve Registry. EuroIntervention, 2019, 15(6): e500-e507.
10.	Lanz J, Reardon MJ, Pilgrim T, et al. Incidence and outcomes of infective endocarditis after transcatheter or surgical aortic valve replacement. J Am Heart Assoc, 2021, 10(19): e020368.
11.	Ried ID, Omran H, Potratz M, et al. Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement. Clin Res Cardiol, 2024, 113(2): 336-352.
12.	Summers MR, Leon MB, Smith CR, et al. Prosthetic valve endocarditis after TAVR and SAVR: insights from the PARTNER trials. Circulation, 2019, 140(24): 1984-1994.
13.	Fernández-Avilés C, Castillo JC, Heredia G, et al. Infective endocarditis on transcatheter aortic prosthesis: are there differences with endocarditis on surgically implanted aortic bioprosthesis? Cardiol J, 2022, 29(3): 511-513.
14.	Fukuhara S, Wu X, Hawkins R, et al. Prosthetic valve endocarditis after transcatheter and surgical aortic valve replacement. Ann Thorac Surg, 2023, 116(2): 314-321.
15.	Cahill TJ, Raby J, Jewell PD, et al. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart, 2022, 108(8): 639-647.
16.	Kutz A, Purtak M, Laager R, et al. Infective endocarditis and cardiac events after transcatheter vs surgical aortic valve replacement: a nationwide cohort study. Int J Infect Dis, 2025, 159: 108011.
17.	Chaudhri M, Al Mahrizi AD, Ali MF, et al. Infective endocarditis after aortic valve replacement: a systematic review and meta-analysis of risks and realities in transcatheter versus surgical repair. Cureus, 2025, 17(6): e86573.
18.	Li S, Nordick KV, Murrieta-álvarez I, et al. Prolonged cardiopulmonary bypass time-induced endothelial dysfunction via glypican-1 shedding, inflammation, and matrix metalloproteinase 9 in patients undergoing cardiac surgery. Biomedicines, 2024, 13(1): 33.
19.	Lindman BR, Goldstein JS, Nassif ME, et al. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart, 2015, 101(7): 537-545.
20.	Erdoes G, Lippuner C, Kocsis I, et al. Technical approach determines inflammatory response after surgical and transcatheter aortic valve replacement. PLoS One, 2015, 10(11): e0143089.
21.	Khan MS, Mir T, Ullah W, et al. Comparing transcatheter aortic valve replacement (AVR) with surgical AVR in lower risk patients: a comprehensive meta-analysis and systematic review. Cardiol Res, 2020, 11(3): 168-178.
22.	Del Val D, Panagides V, Mestres CA, et al. Infective endocarditis after transcatheter aortic valve replacement: JACC state-of-the-art review. J Am Coll Cardiol, 2023, 81(4): 394-412.
23.	Faxon DP, Leopold JA, Abbott JD, et al. Circulation: cardiovascular interventions: the first 10 years. Circ Cardiovasc Interv, 2018, 11(6): e006901.
24.	Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2015, 373(21): 2015-2024.
25.	Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
26.	Varghese JS, Vadiyala MR, Ang SP, et al. Prevalence and outcomes of prosthetic valve endocarditis post-TAVR: a proportion meta-analysis. Circulation, 2022, 146(Suppl 1): 14838.
27.	Ali N, Baig W, Wu J, et al. Prosthetic valve endocarditis following transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown), 2020, 21(7): 510-516.
28.	Alexis SL, Malik AH, George I, et al. Infective endocarditis after surgical and transcatheter aortic valve replacement: a state of the art review. J Am Heart Assoc, 2020, 9(16): e017347.
29.	Berbudi A, Rahmadika N, Tjahjadi AI, et al. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev, 2020, 16(5): 442-449.
30.	Cohen G. Immune dysfunction in uremia 2020. Toxins (Basel), 2020, 12(7): 439.
31.	Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
32.	Franceschi C, Garagnani P, Parini P, et al. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol, 2018, 14(10): 576-590.
33.	Braghieri L, Kaur S, Black CK, et al. Endocarditis after transcatheter aortic valve replacement. J Clin Med, 2023, 12(22): 7042.
34.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
35.	Mentias A, Girotra S, Desai MY, et al. Incidence, predictors, and outcomes of endocarditis after transcatheter aortic valve replacement in the United States. JACC Cardiovasc Interv, 2020, 13(17): 1973-1982.
36.	Di Pietro G, Improta R, De Filippo O, et al. Transcatheter aortic valve replacement in low surgical risk patients: an updated metanalysis of extended follow-up randomized controlled trials. Am J Cardiol, 2024, 224: 56-64.
37.	Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
38.	Brescia AA, Deeb GM, Sang SLW, et al. Surgical explantation of transcatheter aortic valve bioprostheses: a statewide experience. Circ Cardiovasc Interv, 2021, 14(4): e009927.
39.	Ahmad K, Klaaborg KE, Hjortdal V, et al. Prosthetic valve endocarditis after transcatheter aortic valve implantation-diagnostic and surgical considerations. J Thorac Dis, 2016, 8(10): E1213-E1218.
40.	Allen CJ, Patterson T, Chehab O, et al. Incidence and outcomes of infective endocarditis following transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther, 2020, 18(10): 653-662.
41.	Brankovic M, Ansari J, Karanam R, et al. Transcatheter aortic valve replacement as a rescue treatment for prosthetic valve endocarditis. JACC Case Rep, 2022, 4(19): 1306-1310.
42.	Harding D, Cahill TJ, Redwood SR, et al. Infective endocarditis complicating transcatheter aortic valve implantation. Heart, 2020, 106(7): 493-498.

1. Li M, Kim JB, Sastry BKS, et al. Infective endocarditis. Lancet, 2024, 404(10450): 377-392.
2. Ando T, Ashraf S, Villablanca PA, et al. Meta-analysis comparing the incidence of infective endocarditis following transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol, 2019, 123(5): 827-832.
3. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
4. Barreiro L, Roldán á, Aguayo N, et al. Infectious endocarditis on percutaneous aortic valve prosthesis: comparison with surgical bioprostheses. REC Interv Cardiol, 2025, 7(2): 75-81.
5. Calderón-Parra J, de Villarreal-Soto JE, Oteo-Domínguez JF, et al. Risk of infective endocarditis associated with transcatheter aortic valve implantation versus surgical aortic valve replacement: a propensity score-based analysis. J Clin Med, 2023, 12(2): 586.
6. Fauchier L, Bisson A, Herbert J, et al. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect, 2020, 26(10): 1368-1374.
7. Jerónimo A, Olmos C, Zulet P, et al. Clinical characteristics and outcomes of aortic prosthetic valve endocarditis: comparison between transcatheter and surgical bioprostheses. Infection, 2024, 52(6): 2425-2434.
8. Kolte D, Goldsweig A, Kennedy KF, et al. Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States. Am J Cardiol, 2018, 122(12): 2112-2119.
9. Moriyama N, Laakso T, Biancari F, et al. Prosthetic valve endocarditis after transcatheter or surgical aortic valve replacement with a bioprosthesis: results from the FinnValve Registry. EuroIntervention, 2019, 15(6): e500-e507.
10. Lanz J, Reardon MJ, Pilgrim T, et al. Incidence and outcomes of infective endocarditis after transcatheter or surgical aortic valve replacement. J Am Heart Assoc, 2021, 10(19): e020368.
11. Ried ID, Omran H, Potratz M, et al. Infective endocarditis after isolated aortic valve replacement: comparison between catheter-interventional and surgical valve replacement. Clin Res Cardiol, 2024, 113(2): 336-352.
12. Summers MR, Leon MB, Smith CR, et al. Prosthetic valve endocarditis after TAVR and SAVR: insights from the PARTNER trials. Circulation, 2019, 140(24): 1984-1994.
13. Fernández-Avilés C, Castillo JC, Heredia G, et al. Infective endocarditis on transcatheter aortic prosthesis: are there differences with endocarditis on surgically implanted aortic bioprosthesis? Cardiol J, 2022, 29(3): 511-513.
14. Fukuhara S, Wu X, Hawkins R, et al. Prosthetic valve endocarditis after transcatheter and surgical aortic valve replacement. Ann Thorac Surg, 2023, 116(2): 314-321.
15. Cahill TJ, Raby J, Jewell PD, et al. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart, 2022, 108(8): 639-647.
16. Kutz A, Purtak M, Laager R, et al. Infective endocarditis and cardiac events after transcatheter vs surgical aortic valve replacement: a nationwide cohort study. Int J Infect Dis, 2025, 159: 108011.
17. Chaudhri M, Al Mahrizi AD, Ali MF, et al. Infective endocarditis after aortic valve replacement: a systematic review and meta-analysis of risks and realities in transcatheter versus surgical repair. Cureus, 2025, 17(6): e86573.
18. Li S, Nordick KV, Murrieta-álvarez I, et al. Prolonged cardiopulmonary bypass time-induced endothelial dysfunction via glypican-1 shedding, inflammation, and matrix metalloproteinase 9 in patients undergoing cardiac surgery. Biomedicines, 2024, 13(1): 33.
19. Lindman BR, Goldstein JS, Nassif ME, et al. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart, 2015, 101(7): 537-545.
20. Erdoes G, Lippuner C, Kocsis I, et al. Technical approach determines inflammatory response after surgical and transcatheter aortic valve replacement. PLoS One, 2015, 10(11): e0143089.
21. Khan MS, Mir T, Ullah W, et al. Comparing transcatheter aortic valve replacement (AVR) with surgical AVR in lower risk patients: a comprehensive meta-analysis and systematic review. Cardiol Res, 2020, 11(3): 168-178.
22. Del Val D, Panagides V, Mestres CA, et al. Infective endocarditis after transcatheter aortic valve replacement: JACC state-of-the-art review. J Am Coll Cardiol, 2023, 81(4): 394-412.
23. Faxon DP, Leopold JA, Abbott JD, et al. Circulation: cardiovascular interventions: the first 10 years. Circ Cardiovasc Interv, 2018, 11(6): e006901.
24. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2015, 373(21): 2015-2024.
25. Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
26. Varghese JS, Vadiyala MR, Ang SP, et al. Prevalence and outcomes of prosthetic valve endocarditis post-TAVR: a proportion meta-analysis. Circulation, 2022, 146(Suppl 1): 14838.
27. Ali N, Baig W, Wu J, et al. Prosthetic valve endocarditis following transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown), 2020, 21(7): 510-516.
28. Alexis SL, Malik AH, George I, et al. Infective endocarditis after surgical and transcatheter aortic valve replacement: a state of the art review. J Am Heart Assoc, 2020, 9(16): e017347.
29. Berbudi A, Rahmadika N, Tjahjadi AI, et al. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev, 2020, 16(5): 442-449.
30. Cohen G. Immune dysfunction in uremia 2020. Toxins (Basel), 2020, 12(7): 439.
31. Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol, 2017, 70(6): 689-700.
32. Franceschi C, Garagnani P, Parini P, et al. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol, 2018, 14(10): 576-590.
33. Braghieri L, Kaur S, Black CK, et al. Endocarditis after transcatheter aortic valve replacement. J Clin Med, 2023, 12(22): 7042.
34. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
35. Mentias A, Girotra S, Desai MY, et al. Incidence, predictors, and outcomes of endocarditis after transcatheter aortic valve replacement in the United States. JACC Cardiovasc Interv, 2020, 13(17): 1973-1982.
36. Di Pietro G, Improta R, De Filippo O, et al. Transcatheter aortic valve replacement in low surgical risk patients: an updated metanalysis of extended follow-up randomized controlled trials. Am J Cardiol, 2024, 224: 56-64.
37. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
38. Brescia AA, Deeb GM, Sang SLW, et al. Surgical explantation of transcatheter aortic valve bioprostheses: a statewide experience. Circ Cardiovasc Interv, 2021, 14(4): e009927.
39. Ahmad K, Klaaborg KE, Hjortdal V, et al. Prosthetic valve endocarditis after transcatheter aortic valve implantation-diagnostic and surgical considerations. J Thorac Dis, 2016, 8(10): E1213-E1218.
40. Allen CJ, Patterson T, Chehab O, et al. Incidence and outcomes of infective endocarditis following transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther, 2020, 18(10): 653-662.
41. Brankovic M, Ansari J, Karanam R, et al. Transcatheter aortic valve replacement as a rescue treatment for prosthetic valve endocarditis. JACC Case Rep, 2022, 4(19): 1306-1310.
42. Harding D, Cahill TJ, Redwood SR, et al. Infective endocarditis complicating transcatheter aortic valve implantation. Heart, 2020, 106(7): 493-498.

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