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Infective Endocarditis—Update for the Perioperative Clinician

Published:January 05, 2023DOI:https://doi.org/10.1053/j.jvca.2022.12.030
      Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.

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      References

        • Cahill TJ
        • Prendergast BD.
        Infective endocarditis.
        Lancet. 2016; 387: 882-893
        • Baddour LM
        • Wilson WR
        • Bayer AS
        • et al.
        Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications.
        Circulation. 2015; 132: 1186-1435
        • Toyoda N
        • Chikwe J
        • Itagaki S
        • et al.
        Trends in infective endocarditis in California and New York state, 1998-2013.
        JAMA. 2017; 317: 1652-1660
        • Nishimura RA
        • Otto CM
        • Bonow RO
        • et al.
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: e57-185
        • Yew H Sen
        • Murdoch DR
        Global trends in infective endocarditis epidemiology.
        Curr Infect Dis Rep. 2012; 14: 367-372
        • Otto CM
        • Nishimura RA
        • Bonow RO
        • et al.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e72-227
        • Avtaar Singh SS
        • Costantino MF
        • D'Addeo G
        • et al.
        A narrative review of diagnosis of infective endocarditis-imaging methods and comparison.
        Ann Transl Med. 2020; 8: 1621
        • Reynolds HR
        • Jagen MA
        • Tunick PA
        • et al.
        Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era.
        J Am Soc Echocardiogr. 2003; 16: 67-70
        • San Román JA
        • Vilacosta I
        • López J
        • et al.
        Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: One echocardiographic modality does not fit all.
        J Am Soc Echocardiogr. 2012; 25: 807-814
        • Roe MT
        • Abramson MA
        • Li J
        • et al.
        Clinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the Duke criteria.
        Am Heart J. 2000; 139: 945-951
        • Douglas PS
        • Garcia MJ
        • Haines DE
        • et al.
        ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography.
        J Am Soc Echocardiogr. 2011; 24: 229-267
        • Philip M
        • Tessonier L
        • Mancini J
        • et al.
        Comparison between ESC and Duke Criteria for the diagnosis of prosthetic valve infective endocarditis.
        JACC Cardiovasc Imaging. 2020; 13: 2605-2615
        • Yuan X-C
        • Liu M
        • Hu J
        • et al.
        Diagnosis of infective endocarditis using echocardiography.
        Medicine (Baltimore). 2019; 98: e17141
        • Xie P
        • Zhuang X
        • Liu M
        • et al.
        An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis-the timing and mode of assessment (TTE or TEE).
        BMC Infect Dis. 2021; 21: 92
        • Eder MD
        • Upadhyaya K
        • Park J
        • et al.
        Multimodality imaging in the diagnosis of prosthetic valve endocarditis: A brief review.
        Front Cardiovasc Med. 2021; 8750573
        • MacKay EJ
        • Neuman MD
        • Fleisher LA
        • et al.
        Transesophageal echocardiography, mortality, and length of hospitalization after cardiac valve surgery.
        J Am Soc Echocardiogr. 2020; 33 (e1): 756-762
        • Iung B
        • Rouzet F
        • Brochet E
        • Duval X.
        Cardiac Imaging of infective endocarditis, echo and beyond.
        Curr Infect Dis Rep. 2017; 19: 8
        • Koo HJ
        • Yang DH
        • Kang J-W
        • et al.
        Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: Comparison with intra-operative findings.
        Eur Hear J Cardiovasc Imaging. 2018; 19: 199-207
        • Michałowska I
        • Stokłosa P
        • Miłkowska M
        • et al.
        The role of cardiac computed tomography in the diagnosis of prosthetic valve endocarditis - a comparison with transthoracic and transesophageal echocardiography and intra-operative findings.
        Eur J Radiol. 2021; 138109637
        • Oliveira M
        • Guittet L
        • Hamon M
        • et al.
        Comparative value of cardiac CT and transesophageal echocardiography in infective endocarditis: A systematic review and meta-analysis.
        Radiol Cardiothorac Imaging. 2020; 2e190189
        • Jain V
        • Wang TKM
        • Bansal A
        • et al.
        Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: A contemporary comparative meta-analysis.
        J Cardiovasc Comput Tomogr. 2021; 15: 313-321
        • Gomes A
        • van Geel PP
        • Santing M
        • et al.
        Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques.
        J Nucl Cardiol. 2020; 27: 592-608
        • Mgbojikwe N
        • Jones SR
        • Leucker TM
        • et al.
        Infective endocarditis: Beyond the usual tests.
        Cleve Clin J Med. 2019; 86: 559-567
        • Sordelli C
        • Fele N
        • Mocerino R
        • et al.
        Infective endocarditis: Echocardiographic imaging and new imaging modalities.
        J Cardiovasc Echogr. 2019; 29: 149-155
        • Gaca JG
        • Sheng S
        • Daneshmand MA
        • et al.
        Outcomes for endocarditis surgery in North America: A simplified risk scoring system.
        J Thorac Cardiovasc Surg. 2011; 141: 92-98
        • De Feo M
        • Cotrufo M
        • Carozza A
        • et al.
        The need for a specific risk prediction system in native valve infective endocarditis surgery.
        ScientificWorldJournal. 2012; 2012307571
        • Martínez-Sellés M
        • Muñoz P
        • Arnáiz A
        • et al.
        Valve surgery in active infective endocarditis: A simple score to predict in-hospital prognosis.
        Int J Cardiol. 2014; 175: 133-137
        • Gatti G
        • Benussi B
        • Gripshi F
        • et al.
        A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system.
        Infection. 2017; 45: 413-423
        • Olmos C
        • Vilacosta I
        • Habib G
        • et al.
        Risk score for cardiac surgery in active left-sided infective endocarditis.
        Heart. 2017; 103: 1435-1442
        • Di Mauro M
        • Dato GMA
        • Barili F
        • et al.
        A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.
        Int J Cardiol. 2017; 241: 97-102
        • Gatti G
        • Perrotti A
        • Obadia J-F
        • et al.
        Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis.
        J Am Heart Assoc. 2017; 6e004806
        • Gatti G
        • Sponga S
        • Peghin M
        • et al.
        Risk scores and surgery for infective endocarditis: In search of a good predictive score.
        Scand Cardiovasc J. 2019; 53: 117-124
        • Huang S
        • Zhou Z
        • Luo L
        • et al.
        Preoperative serum albumin: A promising indicator of early mortality after surgery for infective endocarditis.
        Ann Transl Med. 2021; 9: 1445
        • Fernandez-Felix BM
        • Barca LV
        • Garcia-Esquinas E
        • et al.
        Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: A systematic review and aggregation of prediction models.
        Clin Microbiol Infect. 2021; 27: 1422-1430
        • Habib G
        • Lancellotti P
        • Antunes MJ
        • et al.
        [2015 ESC Guidelines for the management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)].
        G Ital Cardiol (Rome). 2016; 17: 277-319
        • Wang A
        • Fosbøl EL.
        Current recommendations and uncertainties for surgical treatment of infective endocarditis: A comparison of American and European cardiovascular guidelines.
        Eur Heart J. 2022; 43: 1617-1625
        • Olaison L
        • Pettersson G.
        Current best practices and guidelines. Indications for surgical intervention in infective endocarditis.
        Cardiol Clin. 2003; 21 (vii): 235-251
        • Harky A
        • Zaim S
        • Mallya A
        • George JJ.
        Optimizing outcomes in infective endocarditis: A comprehensive literature review.
        J Card Surg. 2020; 35: 1600-1608
        • Liang F
        • Song B
        • Liu R
        • et al.
        Optimal timing for early surgery in infective endocarditis: A meta-analysis.
        Interact Cardiovasc Thorac Surg. 2016; 22: 336-345
        • Anantha-Narayanan M
        • Reddy YN V
        • Sundaram V
        • et al.
        Endocarditis risk with bioprosthetic and mechanical valves: Systematic review and meta-analysis.
        Heart. 2020; 106: 1413-1419
        • Kousa O
        • Walters RW
        • Saleh M
        • et al.
        Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database.
        J Card Surg. 2020; 35: 2611-2617
        • Tam DY
        • Yanagawa B
        • Verma S
        • et al.
        Early vs late surgery for patients with endocarditis and neurological injury: A systematic review and meta-analysis.
        Can J Cardiol. 2018; 34: 1185-1199
        • Zhang LQ
        • Cho S-M
        • Rice CJ
        • et al.
        Valve surgery for infective endocarditis complicated by stroke: Surgical timing and perioperative neurological complications.
        Eur J Neurol. 2020; 27: 2430-2438
        • Yokoyama Y
        • Goto T.
        Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: A meta-analysis.
        J Cardiothorac Surg. 2021; 16: 49
        • Goodman-Meza D
        • Weiss RE
        • Gamboa S
        • et al.
        Long term surgical outcomes for infective endocarditis in people who inject drugs: A systematic review and meta-analysis.
        BMC Infect Dis. 2019; 19: 918
        • Straw S
        • Baig MW
        • Gillott R
        • et al.
        Long-term outcomes are poor in intravenous drug users following infective endocarditis, even after surgery.
        Clin Infect Dis. 2020; 71: 564-571
        • Ludvigsen LUP
        • Dalgaard LS
        • Wiggers H
        • et al.
        Infective endocarditis in patients receiving chronic hemodialysis: A 21-year observational cohort study in Denmark.
        Am Heart J. 2016; 182: 36-43
        • Chaudry MS
        • Carlson N
        • Gislason GH
        • et al.
        Risk of infective endocarditis in patients with end stage renal disease.
        Clin J Am Soc Nephrol. 2017; 12: 1814-1822
        • Sadeghi M
        • Behdad S
        • Shahsanaei F.
        Infective endocarditis and its short and long-term prognosis in hemodialysis patients: A systematic review and meta-analysis.
        Curr Probl Cardiol. 2021; 46100680
        • Pericàs JM
        • Llopis J
        • Jiménez-Exposito MJ
        • et al.
        Infective endocarditis in patients on chronic hemodialysis.
        J Am Coll Cardiol. 2021; 77: 1629-1640
        • Tutarel O
        • Alonso-Gonzalez R
        • Montanaro C
        • et al.
        Infective endocarditis in adults with congenital heart disease remains a lethal disease.
        Heart. 2018; 104: 161-165
        • Maser M
        • Freisinger E
        • Bronstein L
        • et al.
        Frequency, mortality, and predictors of adverse outcomes for endocarditis in patients with congenital heart disease: Results of a nationwide analysis including 2512 endocarditis cases.
        J Clin Med. 2021; 10: 5071
        • Fournier PE
        • Casalta JP
        • Habib G
        • et al.
        Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis.
        Am J Med. 1996; 100: 629-633
        • Sandoe JAT
        • Barlow G
        • Chambers JB
        • et al.
        Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE).
        J Antimicrob Chemother. 2015; 70: 325-359
        • Antoniou A
        • Harky A
        • Bashir M
        • et al.
        Why I choose to repair and not to replace the aortic valve?.
        Gen Thorac Cardiovasc Surg. 2019; 67: 20-24
        • Hu X
        • Jiang W
        • Xie M
        • et al.
        Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years.
        Clin Cardiol. 2020; 43: 1093-1099
        • Chikwe J
        • Chiang YP
        • Egorova NN
        • et al.
        Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years.
        JAMA. 2015; 313: 1435-1442
        • Kulik A
        • Bédard P
        • Lam B-K
        • et al.
        Mechanical versus bioprosthetic valve replacement in middle-aged patients.
        Eur J Cardiothorac Surg. 2006; 30: 485-491
        • Goldstone AB
        • Chiu P
        • Baiocchi M
        • et al.
        Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement.
        N Engl J Med. 2017; 377: 1847-1857
        • Yanagawa B
        • Mazine A
        • Tam DY
        • et al.
        Homograft versus conventional prosthesis for surgical management of aortic valve infective endocarditis: A systematic review and meta-analysis.
        Innovations (Phila). 2018; 13: 163-170
        • Kytö V
        • Sipilä J
        • Ahtela E
        • et al.
        Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70.
        Ann Thorac Surg. 2020; 110: 102-110
        • Iftikhar SF
        • Ahmad F.
        Tricuspid valve endocarditis.
        StatPearls Publishing, Treasure Island, FL2022
        • Pettersson GB
        • Coselli JS
        • Pettersson GB
        • et al.
        2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary.
        J Thorac Cardiovasc Surg. 2017; 153 (e29): 1241-1258
        • Lanz J
        • Reardon MJ
        • Pilgrim T
        • et al.
        Incidence and outcomes of infective endocarditis after transcatheter or surgical aortic valve replacement.
        J Am Heart Assoc. 2021; 10e020368
        • Fauchier L
        • Bisson A
        • Herbert J
        • et al.
        Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement.
        Clin Microbiol Infect. 2020; 26: 1368-1374
        • Prasitlumkum N
        • Vutthikraivit W
        • Thangjui S
        • et al.
        Epidemiology of infective endocarditis in transcatheter aortic valve replacement: Systemic review and meta-analysis.
        J Cardiovasc Med (Hagerstown). 2020; 21: 790-801
        • Summers MR
        • Leon MB
        • Smith CR
        • et al.
        Prosthetic valve endocarditis after TAVR and SAVR: Insights from the PARTNER trials.
        Circulation. 2019; 140: 1984-1994
        • Jiang W
        • Wu W
        • Guo R
        • et al.
        Predictors of prosthetic valve endocarditis following transcatheter aortic valve replacement: A meta-analysis.
        Heart Surg Forum. 2021; 24: E101-E107
        • Kolte D
        • Goldsweig A
        • Kennedy KF
        • et al.
        Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States.
        Am J Cardiol. 2018; 122: 2112-2119
        • Butt JH
        • Ihlemann N
        • De Backer O
        • et al.
        Long-Term Risk of Infective Endocarditis After Transcatheter Aortic Valve Replacement.
        J Am Coll Cardiol. 2019; 73: 1646-1655
        • Kuttamperoor F
        • Yandrapalli S
        • Siddhamsetti S
        • et al.
        Infectious endocarditis after transcatheter aortic valve replacement: Epidemiology and outcomes.
        Cardiol Rev. 2019; 27: 236-241
        • Regueiro A
        • Linke A
        • Latib A
        • et al.
        Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death.
        JAMA. 2016; 316: 1083-1092
        • Amat-Santos IJ
        • Messika-Zeitoun D
        • Eltchaninoff H
        • et al.
        Infective endocarditis after transcatheter aortic valve implantation: Results from a large multicenter registry.
        Circulation. 2015; 131: 1566-1574
        • SL Alexis
        • Malik AH
        • George I
        • et al.
        Infective endocarditis after surgical and transcatheter aortic valve replacement: A state of the art review.
        J Am Heart Assoc. 2020; 9e017347
        • Mangner N
        • Woitek F
        • Haussig S
        • et al.
        Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2016; 67: 2907-2908
        • Latib A
        • Naim C
        • De Bonis M
        • et al.
        TAVR-associated prosthetic valve infective endocarditis: Results of a large, multicenter registry.
        J Am Coll Cardiol. 2014; 64: 2176-2178
        • Yeo I
        • Kim LK
        • Park SO
        • et al.
        In-hospital infective endocarditis following transcatheter aortic valve replacement: A cross-sectional study of the National Inpatient Sample database in the USA.
        J Hosp Infect. 2018; 100: 444-450
        • Khan A
        • Aslam A
        • Satti KN
        • et al.
        Infective endocarditis post-transcatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review.
        PLoS One. 2020; 15e0225077
        • Stortecky S
        • Heg D
        • Tueller D
        • et al.
        Infective endocarditis after transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2020; 75: 3020-3030
        • Mangner N
        • del Val D
        • Abdel-Wahab M
        • et al.
        Surgical treatment of patients with infective endocarditis after transcatheter aortic valve implantation.
        J Am Coll Cardiol. 2022; 79: 772-785
        • Li JS
        • Sexton DJ
        • Mick N
        • et al.
        Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.
        Clin Infect Dis. 2000; 30: 633-638
        • Hill EE
        • Herijgers P
        • Claus P
        • et al.
        Abscess in infective endocarditis: The value of transesophageal echocardiography and outcome: A 5-year study.
        Am Heart J. 2007; 154: 923-928
        • Vieira MLC
        • Grinberg M
        • Pomerantzeff PMA
        • et al.
        Repeated echocardiographic examinations of patients with suspected infective endocarditis.
        Heart. 2004; 90: 1020-1024
        • Nakatani S
        • Ohara T
        • Ashihara K
        • et al.
        JCS 2017 guideline on prevention and treatment of infective endocarditis.
        Circ J. 2019; 83: 1767-1809
        • Mihos CG
        • Capoulade R
        • Yucel E
        • et al.
        Surgical versus medical therapy for prosthetic valve endocarditis: A meta-analysis of 32 studies.
        Ann Thorac Surg. 2017; 103: 991-1004
        • Pettersson GB
        • Hussain ST.
        Current AATS guidelines on surgical treatment of infective endocarditis.
        Ann Cardiothorac Surg. 2019; 8: 630-644
        • David TE.
        Aortic valve repair for active infective endocarditis.
        Eur J Cardiothorac Surg. 2012; 42: 127-128
        • Chauvette V
        • Bouhout I
        • Lefebvre L
        • et al.
        The Ross procedure is a safe and durable option in adults with infective endocarditis: A multicentre study.
        Eur J Cardiothorac Surg. 2020; 58: 537-543
        • Shih E
        • Squiers JJ
        • DiMaio JM.
        Systematic review of minimally invasive surgery for mitral valve infective endocarditis.
        innovations (Phila). 2021; 16: 244-248