Endocarditis After Transcatheter Aortic Valve Implantation: A New Fiend We Hardly Know

Juan Manuel Monteagudo Ruiz; José Luis Zamorano Gómez


Eur Heart J. 2019;40(39):3270-3272. 

In This Article

Abstract and Introduction


Transcatheter aortic valve implantation (TAVI) has become the first-line treatment option for symptomatic severe aortic stenosis in patients with high and intermediate surgical risk. Recently published data support that TAVI is superior to surgical aortic valve replacement (SAVR) in low-risk patients, at least in the short term.[1,2] Clinical practice will foreseeably shift towards treating low-risk patients with TAVI. Indeed, during the past few years, the numbers of TAVI procedures have surpassed the numbers of isolated SAVR procedures.[3]

The most important limitation is the uncertainty about the long-term clinical outcomes. This is especially relevant given that TAVI will be performed in younger patients with fewer comorbidities. Hence, long-term durability and complications require a closer scrutiny. Initial data regarding the durability are reassuring, but questions about valve dysfunction due to infective endocarditis (IE) after TAVI are emerging. Furthermore, although the overall incidence rate of IE has remained relatively stable in recent years, the epidemiology has changed. In high-income countries, prosthetic valve endocarditis (PVE) has increased, replacing those forms of endocarditis previously related to rheumatic disease.[4] An increase in the incidence of IE in patients with TAVI is therefore expected.

IE after TAVI is a serious complication associated with a high morbidity and mortality (Take home figure). In the current issue of the European Heart Journal, Bjursten et al. provide data that help to improve our understanding of this subject.[5]

Take home figure.

Overview of IE after TAVI.