Heart Valve Endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Heart valve replacement is the primary surgical treatment for infective endocarditis (IE) globally.
• Current guidelines lack specific recommendations for prosthesis selection and surgical strategies in IE.
• Optimizing long-term durability and preventing infection relapse are key goals in IE management.

Purpose of the Study:

• To review current evidence on valve substitutes for IE.
• To propose an evidence-based algorithm for guiding treatment decisions in IE.
• To address the need for improved prosthesis selection and surgical strategies.

Main Methods:

• Comprehensive review of existing literature on valve substitutes in IE.
• Analysis of factors influencing prosthesis choice, including infection characteristics, patient profile, and recurrence risk.
• Development of a decision-making algorithm for IE treatment.

Main Results:

• Mechanical or stented xenografts are preferred for localized IE.
• Homografts are considered for complex IE involving the aortic root or aorto-mitral continuity, balancing degeneration risks.
• Prosthetic bioroot and valved conduits are alternatives for aortic valve endocarditis.

Conclusions:

• Prosthesis selection for IE must be individualized based on infection severity, microbiology, patient condition, and recurrence risk.
• Further research into preservation techniques for allogeneic substitutes is needed to enhance durability.
• An evidence-based algorithmic approach can optimize treatment strategies for infective endocarditis.