Infective Endocarditis in Perceval Sutureless Valves: Incidence, Diagnostic Challenges, and Management: An Expert...

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Medical Imaging

Background:

• Sutureless aortic bioprostheses are increasingly used for aortic valve replacement, especially in elderly and high-risk patients.
• The Perceval valve is a widely studied sutureless device known for good hemodynamics and shorter operation times.
• Prosthetic valve endocarditis (PVE) in Perceval valves, though rare, presents unique diagnostic and management challenges.

Purpose of the Study:

• To review current evidence on endocarditis specifically affecting the Perceval sutureless aortic bioprosthesis.
• To summarize epidemiology, microbiology, diagnostic approaches, treatment strategies, and prognosis.
• To identify gaps in knowledge and areas for future research regarding Perceval valve endocarditis.

Main Methods:

• Literature review of studies on Perceval valve endocarditis.
• Analysis of diagnostic modalities including echocardiography, CT, and PET/CT.
• Examination of treatment outcomes and prognostic factors.

Main Results:

• Perceval PVE incidence is low but associated with significant morbidity and mortality.
• Echocardiographic acoustic shadowing complicates diagnosis, necessitating multimodality imaging.
• Microbiology is similar to other bioprostheses, but perivalvular extension and instability are common, often requiring early surgery.

Conclusions:

• Endocarditis in Perceval valves requires a comprehensive diagnostic approach using multiple imaging techniques.
• Management strategies must consider the valve's fixation mechanism, often leading to early surgical intervention.
• Further research is needed to optimize the treatment and improve outcomes for this specific complication.