Guidelines on prosthetic heart valve management in infective endocarditis: a narrative review comparing American Heart Association/American College of Cardiology and European Society of Cardiology guidelines

Abstract

Infective endocarditis (IE) represented over the last year a growing medical and surgical concern.The changes in etiology and demographic of the disease, which now includes also a large proportion of iatrogenic conditions, has prompted new studies and updates in the guideline for IE treatment. The increasing use of intravascular and intracardiac devices has introduced new challenges in terms of both antibiotic resistance and surgical treatment of prosthetic endocarditis. Also, patients with complex congenital heart diseases, intravenous drug abusers and patients with chronic renal failure under hemodialysis have been added to the list of high-risk subjects for IE. Important aspects concerning the establishment of the endocarditis team, the clinical management, the optimal medical therapy and the indication and timing for surgery are arguments of debate and controversy across the literature. In particular, the most adequate strategy to be adopted in the context of concomitant neurological complication remains greatly debated.Despite attempts to standardize the practice in IE, the lack of powered randomized clinical evidence prevented the achievement of a univocal consensus in several aspects of the management of IE. This situation reflects in some differences in the recommendation promoted by the European Society of Cardiology and American Heart Association/American College of Cardiology. In this review, we will compare the European Society of Cardiology and the American Heart Association guidelines and discuss important aspects related to clinical management and indications of for treatment.

Infective Endocarditis in High-Income Countries

“…Regarding prophylaxis, aminoglycosides are no longer recommended by the ESC and AHA guidelines for the treatment of methicillin-sensitive or methicillin-resistant S. aureus for native valve and cardiac device endocarditis. Although aminoglycosides have represented the class of antibiotics widely used for enterococcus-driven ED, the increasing frequency of resistance, which reaches rates of 25% to 50% in tests reported by recent studies, together with the recognition of potential harm, has driven the ESC Guidelines Committee 2021 to identify ampicillin and ceftriaxone (Class IB recommendation) as treatment of choice for aminoglycoside-resistant Enterococcus faecalis , effective as ampicillin/gentamicin, with decreased levels of nephrotoxicity [ 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 ].…”

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

“…453 In recent years, knowledge has been accumulated regarding timing for surgery from the viewpoint of preventing embolism. 454 Early intervention is superior for patients with cerebral infarction, 455 while early intervention should be avoided for cerebral hemorrhage. 454,456 IE is increasing worldwide nowadays, especially in the elderly.…”

Pathophysiology of Infective Endocarditis in High-Income Countries

“…The use of antibiotic prophylaxis administration has been disclosed to give substantial protection against CDI in both RCTs and observational studies. [188][189][190][191][192][193][194] CDI may develop in various sites, involving the generator pocket, device leads, or endocardial (valvular or non-valvular) surfaces (or any combination of these locations). The main characteristic of the infection located at the level of pocket infections is cellulitis, erythema, wound discharge, and pain.…”