Perspective:

This study observed IE in 0.7% of patients following TAVR, which is comparable to rates previously reported for surgical aortic valve replacement (SAVR). Despite the less invasive nature of TAVR, these patients typically have more comorbidities, which may explain the similar rate of IE. The observation that over one half of patients with IE were exposed to procedures that may cause bacteremia raises important issues regarding the use of antibiotic prophylaxis, and should prompt further study to determine whether current guidelines for antibiotic prophylaxis are adequate. It is also notable that enterococci were a frequent pathogen, as this can be introduced with groin access for the TAVR procedure. The study also reports a higher rate of IE with a self-expanding device. The reason for this is unclear, but one possibility is limited site experience, as 80% of procedures in this study were performed using a balloon-expandable device, and less site experience has been associated with increased rates of complications. It is also possible that there are some intrinsic differences in the device itself or the deployment procedure that alter the risk of IE, and this merits additional study. Finally, very few patients underwent repeat valve intervention, which may have been due to the frequent comorbidities in this population. These individuals had a very poor prognosis, and these results should prompt careful discussion of the management options in these patients.