Abstract 14994: One-Year Mortality and Reoperation among Patients with Infective Endocarditis after Transcatheter or Surgical Aortic Valve Replacement

Background: With improving technology and experience, indications for transcatheter aortic valve implantation (TAVI) have expanded to include younger patients and those at moderate surgical risk, leading to increasing use of TAVI as an alternative to surgical aortic valve replacement (SAVR). As a result, post-TAVI infective endocarditis (IE) is increasingly common. Data on post-TAVI IE in comparison to post-SAVR IE outcomes are limited. Methods: Using data from the TriNetX Research Network, we identified (1) a cohort of patients who underwent TAVI between 1/1/2016 and 12/31/2020 (CPT procedure code 1021150) and developed IE (captured with ICD-10 codes I33, I38, or I39) after the procedure; and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1006141, excluding any associated transcatheter procedures) and developed IE. Both cohorts were required to have at least 1 week follow-up, i.e., deaths within 7 days of IE were excluded. We matched the cohorts for demographics and clinically relevant background characteristics. Results: We identified 713 patients with post-TAVI IE and 713 matched patients with post-SAVR IE. The baseline characteristics were well balanced, as indicated by standardized mean differences <0.1, Table 1. The Kaplan-Meier 1-year mortality between 7 days and 1 year (as deaths before 7 days were excluded) was 18.4% in the TAVI cohort (131 events) vs. 11.4% in the SAVR cohort (81 events), HR 1.62 (95%CI 1.23-2.14; P=0.001). Aortic valve reoperation was uncommon in both groups, with 13 and 10 events in the TAVI and SAVR groups, respectively (1.8% vs. 1.4%; HR 1.43, 95%CI 0.61-3.34; P=0.41). Conclusions: In this comparative, propensity-matched cohort study, 1-year mortality after an episode of IE was higher among TAVI recipients vs. their SAVR counterparts. Repeat aortic valve procedures were uncommon in both groups. Prospective studies are needed to elucidate the causes of excess mortality among TAVI recipients.