Alternatives to Allografts for Aortic Endocarditis: Bioprosthetic and Mechanical Valves

While allograft replacement for aortic valve endocarditis is appealing due to its potentially lower risk of re-infection, challenges with its use include difficulty with implantation, concerns about durability, and in some cases lack of training or availability remain. There are a variety of alternatives to allograft implantation for aortic valve endocarditis including aortic valve repair, mechanical aortic valve replacement, and the most common alternative—bioprosthetic aortic valve replacement. While there are no randomized data comparing techniques, in the case of native valve endocarditis with preserved anulus, both guidelines and expert opinion would recommend valve replacement with either a bioprosthetic or mechanical valve. If there is extensive annular destruction or prosthetic valve, endocarditis allografts can be considered, but replacements with valved conduit with bioprosthetic and mechanical valve remain excellent alternatives capable of achieving comparable survival, re-infection, and reoperation rates when compared to allografts.