Should the Risk of Infective Endocarditis Impact the Choice of Prosthesis for Noninfective Valve Pathologies?

In patients requiring heart valve replacement for valve disease, several factors should be considered when choosing the type of prosthetic heart valve. Current guidelines do not mention the future risk of prosthetic valve endocarditis as a factor to consider when choosing the prosthesis. Prosthetic valve endocarditis occurs at rates similar to those of other important complications following heart valve replacement. We herein summarize the current knowledge in this field to determine whether the future risk of prosthetic valve endocarditis should influence the choice of prosthesis in heart valve replacement for noninfectious pathologies. The existing evidence indicates that the risk of prosthetic valve endocarditis is higher in patients with biological than mechanical valves, although the level of evidence is low. Overall, there is no strong scientific foundation to guide the valve choice in relation to the risk of prosthetic valve endocarditis. Consequently, the valve choice should continue to be informed by factors such as patient preference, life expectancy, valve durability, and risk of bleeding rather than the risk of prosthetic valve endocarditis.