Key result
A systematic review of contemporary surgical management for aortic valve endocarditis proposes an evidence-based algorithm for valve substitute selection based on infection extent and patient profile.
Why the study?
Detailed guidelines on prosthesis selection and surgical strategies for aortic valve infective endocarditis guided by infection extension, microbiology, patient profile, and recurrence risk are lacking.
What is the optimal surgical management and choice of valve substitute for patients with aortic valve endocarditis?
Systematic Review
What is the optimal surgical management and choice of valve substitute for patients with aortic valve endocarditis?
This systematic review proposes an evidence-based algorithm to guide the choice of valve substitutes in aortic valve endocarditis based on the extension of infection and patient profile.
Informs valve selection by infection extent in aortic endocarditis surgery; extends evidence synthesis into a practical algorithm.
Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.
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Nappi et al. (2020) conducted a systematic review in Aortic valve endocarditis. Surgical management was evaluated. A systematic review of contemporary surgical management for aortic valve endocarditis proposes an evidence-based algorithm for valve substitute selection based on infection extent and patient profile.
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