ObjectiveTo systematically compare the incidence, microbiological profile, and outcomes of infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). MethodsA systematic literature search was conducted in the CNKI, Wanfang, VIP, SinoMed, PubMed, the Cochrane Library, Embase, and Web of Science databases for relevant studies published from their inception to August 2025. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The quality of cohort studies was evaluated using the modified Newcastle-Ottawa Scale (NOS), and randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias tool 2 (RoB 2). A meta-analysis was performed using Stata 19.0. ResultsA total of 12 cohort studies and 1 RCT, encompassing over 200 000 patients, were included. The modified NOS scores for all cohort studies were ≥7 points, and the RCT was rated as having a low overall risk of bias. The overall incidence of IE was significantly lower after TAVR than that after SAVR [RR=0.73, 95%CI (0.59, 0.90), P<0.01]. However, early IE (within 12 months) occurred more frequently following TAVR, though the difference was not statistically significant [RR=1.23, 95%CI (0.87, 1.75), P=0.24]. Reoperation for IE was markedly less common in the TAVR group [RR=0.31, 95%CI (0.20, 0.47), P<0.01]. There were no significant differences in in-hospital mortality or 1-year mortality between the two groups. Regarding the microbiological profile, no significant differences were observed in the distribution of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus spp., and Enterococcus spp. (P>0.01). ConclusionTAVR is associated with a lower overall risk of IE but a higher risk of early IE compared to SAVR. Although reoperation is less common in TAVR patients, mortality rates are comparable. The microbiological etiology is consistent between procedures.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.
