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Infective endocarditis in transcatheter and surgical aortic valve prostheses
  1. Zahra Raisi-Estabragh1,
  2. Rodrigo Bagur2,
  3. Mamas A Mamas3
  1. 1 Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, UK
  2. 2 Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
  3. 3 Keele Cardiovascular Research Group, Keele University, Keele, UK
  1. Correspondence to Prof Mamas A Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK; mamasmamas1{at}yahoo.co.uk

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Aortic stenosis is the most common form of valvular heart disease in Europe and North America, with rapidly rising prevalence owing to the ageing population. Individuals with severe aortic stenosis, particularly those who are symptomatic, have an extremely poor prognosis without intervention, with a mortality rate of over 50% at 2 years.1 Prior to the introduction of transcatheter techniques, surgical aortic valve replacement (SAVR) was the standard of care for the treatment of patients with aortic stenosis. However, surgical risk associated with SAVR precluded many high-risk elderly multimorbid patients from receiving any intervention. Transcatheter aortic valve implantation (TAVI) has emerged as an effective and increasingly utilised option across operative risk strata demonstrated through a series of landmark clinical trials that have led to the use of TAVI in routine clinical practice.

Clinical trials studying the comparative efficacy of SAVR and TAVI have focused on short-term and medium-term endpoints of mortality, disabling stroke and hospitalisation. However, the greatly expanded remit of TAVI in recent years necessitates examination of other key events and longer-term outcomes that may inform clinical decisions on the mode of intervention. Indeed, questions remain over structural valve degeneration, as well as rates and clinical consequences of reintervention, conduction abnormalities, paravalvular leak (PVL), and infective endocarditis (IE).

Patients with prosthetic valves are at increased risk of IE with a poor subsequent clinical course. However, as the occurrence of IE is rare, existing randomised trials are insufficiently powered to capture comparative rates, trends and associations of IE among SAVR and TAVI patients. This is further augmented by the tendency towards recruitment into trials of lower risk patients, meaning that data around IE risk following valvular interventions from such trials is limited. Consequently, there is uncertainty about differential occurrence and determinants of IE between SAVR and TAVI. Such analyses require larger …

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Footnotes

  • Twitter @MMamas1973

  • Contributors ZR-E wrote the first draft, RB and MM edited paper for important intellectual content. MM acted as supervisor.

  • Funding ZR-E recognises the National Institute for Health Research (NIHR) Integrated Academic Training programme which supports her Academic Clinical Lectureship post and was also supported by British Heart Foundation Clinical Research Training Fellowship No FS/17/81/33318.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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