INFECTIVE endocarditis after TAVR was significantly less frequent than after surgical valve replacement, US electronic records show. The findings, presented at IDWeek 2026, add large-scale data to a comparison that has produced conflicting results.
TAVR Versus SAVR in a National Cohort
Researchers conducted a retrospective study using a US electronic health record database and identified 373,946 aortic valve replacement procedures performed between January 1, 2018, and December 31, 2025. Of these, 262,465 were transcatheter aortic valve replacement and 111,481 were surgical aortic valve replacement. Endocarditis cases were captured with ICD-10 codes, excluding noninfectious causes, and classified as early (within 3 months of the procedure) or late (after 3 months).
Overall, 3.44% of patients developed IE. Incidence was 2.63% after TAVR and 5.37% after SAVR (p<0.001), a 51% lower rate with the transcatheter approach. Early IE incidence trended upward over the study period in both groups (p=0.027 for TAVR; p=0.028 for SAVR). Late IE rose initially in both cohorts but fell sharply after 2023, likely reflecting shorter available follow-up.
Pathogen Profile of Infective Endocarditis After TAVR
Staphylococcus aureus was the most common bloodstream pathogen in both groups and occurred less often after TAVR than SAVR (29.7% vs 36.1%; OR: 0.75; 95% CI: 0.68 to 0.82). Enterococcus faecalis was the second most frequent organism, identified in 20.3% and 15.7% of cases, respectively. Women made up 41.3% of IE cases after TAVR compared with 28.0% after SAVR (p<0.001).
Age and Mortality Differences
TAVR recipients were older: 40.3% were aged 80 years or older, compared with 5.9% of SAVR recipients. They were also less socioeconomically vulnerable. Among patients without IE, 12-month mortality was higher after TAVR than SAVR (7.15% vs 5.05%; p<0.001). In patients who developed IE, mortality did not differ significantly between groups (7.98% vs 8.71%; p=0.134).
Clinical Implications
The older age of TAVR recipients may explain the higher 1-year mortality in that group. Once IE developed, however, the survival difference was no longer significant. Lower rates of infective endocarditis after TAVR do not remove the risk, and the data highlight the importance of effective infection prevention measures after valve replacement, whichever approach is used.
Reference
Estrada G et al. Infective endocarditis incidence is lower after TAVR compared to SAVR: Epic Cosmos database. IDWeek, October 21-24, 2026.
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