Prosthetic valve selection in patients with left-sided endocarditis: bioprosthetic or mechanical valves?

Studies comparing outcomes in left-sided endocarditis based on the prosthesis selected for implantation are limited and no randomized studies have been performed. The purpose of this review is to summarize the best available studies to determine what prosthesis is most appropriate when valve replacement is necessary for left-sided endocarditis.

Recommendations for valve selection in left-sided endocarditis depend on patient age and whether the infection occurs in a native or prosthetic valve. In young patients with native valve endocarditis (NVE), the algorithm for valve selection should mimic the algorithm for noninfectious indications. For older patients with NVE, bioprosthetic valves are appropriate and offer favorable freedom from reoperation and survival compared with mechanical valves. For all patients with prosthetic valve endocarditis, bioprosthetic valves are reasonable given diminished long-term survival compared with those with native valve infections. Homografts can be considered when extensive aortic annular destruction is present in experienced centers, but the Ross procedure is of limited value in endocarditis.

Valve procedure and valve prosthesis selection when replacement is indicated can profoundly impact both short-term and long-term patient outcomes in left-sided endocarditis. Review of recent studies demonstrates specific subgroups in which bioprosthetic versus mechanical valves are preferable.