Challenges in Infective Endocarditis

Thomas J. Cahill, MBBS; Larry M. Baddour, MD; Gilbert Habib, MD; Bruno Hoen, MD, PHD; Erwan Salaun, MD; Gosta B. Pettersson, MD, PHD; Hans Joachim Schäfers, MD; Bernard D. Prendergast, DM


J Am Coll Cardiol. 2017;69(3):325-344. 

In This Article


The challenges of IE are diverse, but many are tractable (Central Illustration). Prevention is undoubtedly better than cure. Translating advances in materials science into prosthetic devices with reduced susceptibility to bacterial adhesion would be revolutionary. Understanding the relative importance of dental procedures for patients with known cardiac risk factors would help direct use of antibiotic prophylaxis. The value of integrated diagnostic strategies using multimodality imaging is emerging and needs refinement on the basis of real-world patient cohorts. Surgical treatment plays an increasing role, but the current wide variation in outcomes suggests that management should be concentrated in larger valve centers of excellence. Further improving the quality and breadth of the evidence base through new RCTs is essential. At the time of writing, only 6 RCTs in IE are shown as currently recruiting. Trials may be difficult to design but are eminently achievable and could be used to assess novel antibiotic strategies, as well as indications for surgery and optimal timing of surgery. The ESC and AHA, in collaboration with the surgical societies, are well placed to host and coordinate such studies, which will need to be multicenter and multinational in design and rely on noncomposite, hard endpoints, such as mortality. Now is the time to transform current challenges in IE into answers.

Central Illustration.

Infective Endocarditis: Preventive Strategies, Diagnosis, and Management