Infective endocarditis is caused when a bacterium such as staphylococcus enters the bloodstream and infects heart valves that control the circulation of blood flow through the heart. Although uncommon, it can impact those with pre-existing conditions, such as heart valve disease, or behaviors such as intravenous drug use. Occasionally an infection can become complicated and require that patient to have a valve replacement. The choice of valve, whether bioprosthetic or mechanical, remains an ongoing topic of discussions among professionals and is typically a highly individualized decision. But what does the current literature tell us and how does it influence current recommendations?
A study published in the Annals of Cardiothoracic Surgery in 2019 reviewed outcomes such as overall survival and reinfection in patients undergoing replacement with both valve types. Among the population studied, no significant differences were found in terms of outcome regardless of whether the patient received a bioprosthetic or mechanical valve. Although earlier studies published by the Public Library of Science suggested that mechanical valves may be associated with a better prognosis, the study also mentioned that a large retrospective study included in the analysis showing a high risk of mortality in the bioprosthetic group may have been related to patient characteristics rather than the valve itself.
The recently published 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease addressed the topic of what type of valve to select in those with specific types of valvular heart disease. However, the type of valve to use in patients that have had Infective Endocarditis is not specifically addressed. The choice of valve type in a patient for which intervention is needed should be the result of shared decision making. For example, given the longevity of a mechanical valve, this may be a preferrable recommendation for a younger patient however, if the patient doesn’t want to be on life-long anticoagulation due to a desire to become pregnant in the future, they may opt for a bioprosthetic. Therefore, the decisions as to what type of valve to implant should take into account not only individual risk factors but the specific desires of the patient as well.