Sutureless and Trans-catheter Valve Use in Aortic Valve Endocarditis: A Review

New approaches have been developed to treat aortic valve disease, including sutureless and trans-catheter aortic valve replacement (TAVR). Few groups have reported their experience using sutureless and trans-catheter valves for aortic valve endocarditis. We aim to review the current available data on the application of these two approaches managing aortic valve endocarditis. A literature search was conducted on PubMed, EBSCOhost, and Google scholar databases using the following search terms: "Perceval endocarditis"; "sutureless valve endocarditis"; "Intuity valve endocarditis"; "TAVR endocarditis"; "percutaneous aortic valve endocarditis"; "Trans-catheter valve endocarditis". After filtering, we found 26 articles appropriate for our view including 20 articles about sutureless valves for endocarditis (16 Perceval, 4 Intuity), and 6 articles on trans catheter aortic valve implantation for endocarditis. The observed early mortality rate of sutureless valve implantation in aortic valve endocarditis ranged between 14-23%, while early mortality rates in a recent national sample of the standard surgical approach were between 8-10%. Additionally, there was an observed increased incidence of peri-valvular aortic regurgitation after sutureless valve implantation for endocarditis. We observed an increased risk of stroke for trans-catheter implantation in aortic valve endocarditis with large vegetations. The current evidence suggests caution for the implantation of trans-catheter and sutureless valves in patients with aortic valve endocarditis. High risk patients for the standard surgical approach or complex endocarditis cases should be evaluated through a multidisciplinary endocarditis team at specialized centers.