Prosthetic Valve Endocarditis

Abstract

Cardiovascular infections are a heterogenous group of conditions that can affect various components of the native structure of the heart (pericardium, muscle, endocardium, valves, autonomic nerves, and the vessels) as well as implanted devices such as valve prostheses (all types of prosthetic valves, annuloplasty rings, intracardiac patches, and shunts), cardiovascu-lar implantable electronic devices (CIED), left ventricular assist device catheters, and vascular grafts. The increased use of implantable devices and surgical biomaterials during the last decades have resulted in an increase in related infections as well as associated complications. For example, the expected number of heart valve interventions is estimated to reach more than 800,000 annual procedures worldwide by 2050 [1]. Healthcareassociated infections are the most common noncardiac complication following cardiac surgery and device implantation affecting about 1.7 million patients each year and associated with nearly 100,000 deaths in the US alone [2,3].Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality and whose incidence and severity have remained unchanged or even increased, despite improvements in diagnostic and therapeutic strategies [4,5]. Recent data such as from the EuroEndo registry, the most comprehensive and far-reaching observational international study involving a cohort of 3116 adult with IE recruited between January 2016 and March 2018 in 40 countries, showed that in-hospital mortality remains very high-around 17.1% of patients-and was more frequent in prosthetic valve endocarditis (PVE). Independent predictors of mortality were the Charlson index, creatinine >2 mg/dL, congestive heart failure, vegetation length >10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated [6].