Prevalence of Infective Endocarditis in Patients Undergoing Transcatheter Aortic ValveReplacement at a Referral Center

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Abstract

Background: Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare but serious complication
with a generally unfavorable outcome.

Objective: The aim of this study was to describe the incidence, characteristics, and in-hospital outcome of IE after TAVR.

Methods: We conducted a single-center, observational and retrospective study of patients > 18 years who underwent TAVR
between March 2015 and May 2025. Infective endocarditis was classified as early (within one year following TAVR) or late
(>1 year) according to the modified Duke criteria. Clinical, microbiological, and imaging characteristics were analyzed, as
well as treatments received, indication for surgery and in-hospital mortality.

Results: 521 patients were included; median age was 84 years (interquartile range, IQR, 79-87) and 65 % were women. The
incidence of IE was 2.3% (n = 12); 42% of cases corresponded to early IE and 58% to late IE. The median age of the subgroup
with IE was 83 years (IQR 78-86) and 75% were men. Enterococcus faecalis was the most common microorganism. Eight
patients presented with fever as an initial symptom, nine had echocardiographic vegetations, and four presented embolisms.
Four patients had indication for surgery but only one was operated on. In-hospital mortality was 16%; these two patients had
indication for surgery, but the intervention was not carried out due to frailty. All the patients received antibiotic treatment
guided by an antibiogram and one-third received suppressive treatment during follow-up.

Conclusions: In our cohort, the prevalence of IE after TAVR was 2.3%. Its clinical progression, with high morbidity and mortality
rates and limited surgical options, underscores the need for early diagnostic and therapeutic strategies to improve the outcome.