Infective Endocarditis risk in patients with bicuspid aortic valve: systematic review and meta-analysis

Antibiotic prophylaxis in bicuspid aortic valve patients is currently a matter of debate. Although it is no longer recommended by international guidelines, some studies indicate a high risk of infective endocarditis. We aim to evaluate the risk of native valveinfective endocarditis inbicuspid aortic valve patients and compare to individuals with tricuspid aortic valve. Study search of longitudinal studies regarding infective endocarditis incidence in bicuspid aortic valve patients (compared with tricuspid aortic valve/overall population) was conducted through OVID in the following electronic databases: MEDLINE, CENTRAL, EMBASE; from inception until October 2020. The outcomes of interest were the incidence rate and relative risk of infective endocarditis. The relative risk and incidence rate (number of cases for each 10 000 persons-year) with their 95% confidence intervals (95%CI) were estimated using a random effects model meta-analysis. The study protocol was registered at PROSPERO CRD42020218639. Eight cohort studies were selected, with a total of 5351 bicuspid aortic valve patients. During follow up, 184 bicuspid aortic valve patients presented infective endocarditis, with an incidence rate of 48.13 per 10,000 patients-year (95%CI 22.24-74.02), and a 12-fold (RR: 12.03, 95%CI 5.45-26.54) increased risk compared with general population, after adjusted estimates. This systematic review and meta-analysis suggests that bicuspid aortic valve patients have a significant high risk of native valve infective endocarditis. Large prospective high-quality studies are required to estimate more accurately the incidence of infective endocarditis, the relative risk and the potential benefit of antibiotic prophylaxis.