Incidence of Infective Endocarditis Following Surgical or Transcatheter Mitral Valve Repair or Replacement: A Systematic Review and Meta-Analysis

Abstract Aims Infective endocarditis (IE) is a serious and potentially fatal complication of mitral valve (MV) intervention. There are limited data comparing the incidence of IE after MV repair compared with bioprosthetic MV replacement. The aim of this study was to analyse the incidence and timing of IE after MV repair compared with bioprosthetic valve replacement, in both surgical and transcatheter patient populations. Methods A literature search of Medline, Embase, and Cochrane Library (January 2000 – September 2025) was conducted. Pooled IE incidence rates were derived using random-effects models. Results 82 studies (80,939 patients, total follow-up 350,252 patient-years) were included. The overall incidence rate of IE was 0.97 per 100-patient-years (95%CI 0.71-1.34). IE was more common after surgical MV replacement (SMVR) than surgical MV repair (SMVr): incidence rate 0.93 (95%CI 0.41-1.81) vs. 0.39 (95%CI 0.25-0.62) per 100-patient-years, incidence rate ratio (IRR) 2.34 (95%CI 1.06-5.18), p=0.035. The incidences of IE after transcatheter MV replacement (TMVR) was comparable to transcatheter MV repair (TMVr) (2.88 95%CI 1.91-4.33 vs. 1.70 95%CI 0.84-3.43 per 100-patient-years), IRR 1.56 (95%CI 0.73-3.34), p=0.250. The cumulative incidence of IE following SMVR was significantly higher than following SMVr at 1 and 2 years post-procedure, but not at 6 months. Conclusions Infective endocarditis is an infrequent complication of mitral valve intervention. The incidence of IE following SMVR is significantly higher than following SMVr, while the incidence of IE following TMVR is numerically but not significantly higher than following TMVr. Reducing IE risk after mitral intervention is a clinical and research priority.