Response to Letters Regarding Article, “Infective Endocarditis After Transcatheter Aortic Valve Implantation: Results From a Large Multicenter Registry”

We appreciate the interest of Thuny et al and Pericas et al in our work.1 Both sets of authors raised concerns about potentially underestimating the real incidence of infective endocarditis (IE) in our study. Although this possibility cannot be completely excluded, it is important to note that the incidence of IE in our series is similar to what was reported in the Placement of Aortic Transcatheter Valve (PARTNER) trial.2 Thuny et al pointed out the limitations of transesophageal echocardiography for diagnosing IE, including periannular complications, highlighting the potential added value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in this setting. Unfortunately, no data on the use of this imaging technique were available in our study. However, transesophageal echocardiography has been demonstrated to be useful in detecting periannular complications within the context of IE, with a diagnostic accuracy of >90%,3,4 although certain technical aspects of transcatheter aortic valve implantation (TAVI) may alter this rate somewhat. In addition, the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography within the first 6 months after intervention (≈50% of patients in our series) may be limited by the potential occurrence of false-positive results related to concomitant inflammatory status in this early postintervention period.4 Novel imaging techniques are undoubtedly playing an emerging role in the diagnostic workup of IE, and we agree that the Duke criteria …