From the Guidelines
The organism causing aortic valve endocarditis requiring surgical intervention is most likely Staphylococcal aureus, as it is a highly resistant organism that can lead to severe complications.
Key Points
- The decision to perform surgical intervention should be made by a multispecialty Heart Valve Team of cardiology, cardiothoracic surgery, and infectious disease specialists 1.
- Early surgery is indicated in patients with left-sided IE caused by Staphylococcal aureus, fungal, or other highly resistant organisms 1.
- Other indications for early surgery include valve dysfunction resulting in symptoms of heart failure 1, and complications such as heart block, annular or aortic abscess, or destructive penetrating lesions 1.
- The European Society of Cardiology guidelines also recommend surgical treatment in approximately half of the patients with IE due to severe complications, and emphasize the importance of early consultation with a cardiac surgeon to determine the best therapeutic approach 1.
From the Research
Organism Causing Aortic Valve Endocarditis
The organism causing aortic valve endocarditis requiring surgical intervention can vary. Some of the identified causative microorganisms include:
- Staphylococcus aureus, which is a common cause of surgical prosthetic-valve infective endocarditis (IE) 2, 3, 4
- Streptococcus gordonii, an oral commensal that can cause infective endocarditis, particularly in patients with a history of odontological procedures 5
- Cardiobacterium valvarum, a rare HACEK group microorganism that can cause infective endocarditis and extra-cardiac manifestations such as endograft involvement and osteomyelitis 6
Risk Factors and Outcomes
Some of the risk factors associated with aortic valve endocarditis include:
- Recent history of odontological procedures 5
- Presence of a congenital bicuspid aortic valve 5
- Use of prosthetic valves, such as those used in transcatheter aortic valve replacement (TAVR) 2, 3, 4
- Presence of comorbidities such as cardiogenic shock, acute kidney injury, and stroke 2, 3
The outcomes of aortic valve endocarditis can be severe, with high in-hospital and late mortality rates 2, 3. Surgical intervention may be necessary in some cases, particularly in patients with complicated infective endocarditis or those who do not respond to medical therapy alone 2, 5. However, the decision to proceed with surgical intervention should be made on a case-by-case basis, taking into account the individual patient's risk factors and overall health status.