Scholarlink

Background <p>Infective endocarditis (IE) carries in-hospital mortality of 15–20% and 1-year mortality approaching 40%, with surgery required in 40–50% of cases. IE is not uniformly distributed across cardiac valves aortic 30–45%, mitral 25–30%, tricuspid 5–10%, pulmonary &lt; 2%, PVE 10–30% and this distribution reflects valve-specific anatomical determinants governing surgical complexity and outcomes. Despite the 2023 ESC Guidelines, a unified structural framework linking anatomical vulnerability to surgical decision-making remains absent.</p> Objective <p>To propose a valve-specific structural vulnerability framework and examine its implications for surgical complexity, perioperative outcomes, and re-surgery risk across all cardiac valve types.</p> Methods <p>A narrative review of peer-reviewed literature (2015–2025) was conducted across PubMed, Scopus, and MEDLINE. Systematic reviews, meta-analyses, multicentre registries, and guideline documents were synthesised narratively.</p> Key Findings <p>A structural vulnerability gradient (prosthetic valves &gt; aortic &gt; mitral &gt; tricuspid &gt; pulmonary) is proposed as a conceptual model of valve-specific disease behaviour. Aortic IE carries maximal vulnerability through peri-annular extension, 30–40% of cases, requiring radical root reconstruction with elevated operative mortality. Mitral IE exhibits conditional vulnerability; repair yields superior outcomes over replacement. Tricuspid IE is predominantly IVDU-associated with comparatively lower operative mortality. PVE carries the highest operative risk, with prolonged operative times and significant reoperation rates.</p> Conclusions <p>IE is best understood as a valve- and substrate-specific disease in which anatomical determinants drive surgical complexity and clinical prognosis. This proposed vulnerability hierarchy may enable preoperative risk stratification, inform valve-specific surgical planning, and provide a mechanistic framework for understanding differential outcomes across valve types. Prospective outcome registries and standardised complexity metrics are needed to validate and refine this conceptual model.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Valve-specific structural vulnerability in infective endocarditis: a narrative review of surgical complexity and outcomes

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月17日

查看全文
  • Najmi Hakim Abd Rani,
  • Afifah Mohamed,
  • Zaleha Md Isa,
  • Suhaini Kadiman,
  • Taty Anna Kamarudin

摘要

Background

Infective endocarditis (IE) carries in-hospital mortality of 15–20% and 1-year mortality approaching 40%, with surgery required in 40–50% of cases. IE is not uniformly distributed across cardiac valves aortic 30–45%, mitral 25–30%, tricuspid 5–10%, pulmonary < 2%, PVE 10–30% and this distribution reflects valve-specific anatomical determinants governing surgical complexity and outcomes. Despite the 2023 ESC Guidelines, a unified structural framework linking anatomical vulnerability to surgical decision-making remains absent.

Objective

To propose a valve-specific structural vulnerability framework and examine its implications for surgical complexity, perioperative outcomes, and re-surgery risk across all cardiac valve types.

Methods

A narrative review of peer-reviewed literature (2015–2025) was conducted across PubMed, Scopus, and MEDLINE. Systematic reviews, meta-analyses, multicentre registries, and guideline documents were synthesised narratively.

Key Findings

A structural vulnerability gradient (prosthetic valves > aortic > mitral > tricuspid > pulmonary) is proposed as a conceptual model of valve-specific disease behaviour. Aortic IE carries maximal vulnerability through peri-annular extension, 30–40% of cases, requiring radical root reconstruction with elevated operative mortality. Mitral IE exhibits conditional vulnerability; repair yields superior outcomes over replacement. Tricuspid IE is predominantly IVDU-associated with comparatively lower operative mortality. PVE carries the highest operative risk, with prolonged operative times and significant reoperation rates.

Conclusions

IE is best understood as a valve- and substrate-specific disease in which anatomical determinants drive surgical complexity and clinical prognosis. This proposed vulnerability hierarchy may enable preoperative risk stratification, inform valve-specific surgical planning, and provide a mechanistic framework for understanding differential outcomes across valve types. Prospective outcome registries and standardised complexity metrics are needed to validate and refine this conceptual model.