Invasive versus conservative management in infective endocarditis after transcatheter aortic valve implantation: A systematic review and meta-analysis.

BACKGROUND

Infective endocarditis after transcatheter aortic valve implantation (TAVI-IE) is an uncommon but severe complication associated with substantial morbidity and mortality. Therapeutic strategies vary widely, since invasive management is often precluded by prohibitive risk and conservative medical therapy may be linked to poorer outcomes. Therefore, we aimed to compare outcomes between conservative and invasive management in patients with TAVI-IE.

METHODS

A systematic search of PubMed, Scopus, and Web of Science identified comparative studies evaluating conservative versus invasive treatment in TAVI-IE. The primary endpoints were all-cause in-hospital and 1-year mortality. Pooled risk ratios (RRs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was quantified with I², publication bias was assessed with Egger's test, and sensitivity analyses (leave-one-out, GOSH plots) were performed.

RESULTS

The search yielded 2,551 records; 15 studies met inclusion criteria for data extraction and meta-analysis. No significant differences were observed between conservative and invasive strategies for in-hospital mortality (RR 0.99, 95 % CI 0.80-1.24, p = 0.96; I² = 0 % with p = 0.67) or 1-year mortality (RR 1.03, 95 % CI 0.84-1.26; p = 0.81; I² = 11.4 % with p = 0.33). There was no evidence of publication bias (Egger's test: in-hospital, p = 0.07; 1-year, p = 0.54). Results were robust in sensitivity analyses.

CONCLUSIONS

In patients with TAVI-IE, conservative and invasive treatments were associated with comparable in-hospital and 1-year mortality. These findings support individualized, multidisciplinary decision-making rather than presuming a uniform advantage of either approach.