Infective endocarditis on bicuspid aortic valves predominantly affects young men, is often of oral origin, and carries a high rate of surgical indication and mortality despite intervention.
Bicuspid aortic valve (BAV) is the most common congenital heart malformation, affecting 1–2% of the population, with male predominance. BAV may be normofunctional and unrecognized. It carries risk of complications, among which infective endocarditis (IE) is one of the most frequent and severe (second only to valvular dysfunction and aortic aneurysm). Our objective was to describe clinical characteristics of patients with IE on BAV (IE-BAV) in a reference cardiac surgery center. Prospective observational cohort study with consecutive inclusion of adult patients hospitalized with IE from 01/01/2006 to 15/05/2025. Data on IE-BAV episodes were analyzed post hoc. IE-BAV occurred in 35/578 (6%) of IE cases and in 35/82 (42.7%) of congenital heart disease cases. Men predominated (30/35, 85.7%); mean age was 39.1±14.0 years. Previous heart failure occurred in 10/35 (28.57%) and prior IE in 2/35 (5.7%). Acquisition was community-acquired in 30/35 (85.7%), hospital-acquired in 2/35 (5.7%), and healthcare-associated (non-hospital) in 3/35 (8.6%). Blood cultures were collected in all cases, with 22 (62.9%) positive. The main agents identified were oral microorganisms in 12/22 (54.5%) and staphylococci in 6/22 (27.2%). Transthoracic echocardiography was performed in 33/35 (94.3%) and transesophageal echocardiography in 24/35 (68.6%). Aortic regurgitation was identified in 24 (68.6%), aortic vegetations in 24 (68.6%), and mitral vegetations in 6 (17.1%). Abscess, perforation, and fistula were present in 17 (48.6%), 8 (22.9%), and 3 (8.6%) cases, respectively. Fever, new murmur, and embolization occurred in 32/35 (91.4%), 21/35 (60%), and 18/35 (51.4%), respectively. Among embolic events, 14/18 (77.7%) involved the spleen and 3/18 (16.7%) peripheral sites. Main complications were acute heart failure in 23/35 (65.7%), myocardial abscess in 19/35 (54.2%), acute kidney injury in 11/35 (31.4%), recurrent embolization in 3/35 (8.5%), new conduction disturbances in 3/35 (8.5%), and cerebral mycotic aneurysm in 2/35 (5.7%). Surgical indication was present in 34/35 (97%), and 31/34 (91%) underwent surgery. Overall, 6/35 (17.1%) patients died. IE-BAV affected young patients, most of whom were unaware of having BAV. Infection was predominantly of oral origin. Almost all patients had surgical indication and were operated on. Despite this, mortality was high, underscoring the importance of early diagnosis and timely surgical intervention.
Rodrigues et al. (2026) studied this question.