What are AHA guidelines on the prevention of infective endocarditis (IE) in patients with high-risk cardiac conditions?

Updated: Jul 28, 2020
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Buck Christensen  more...
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Answer

Answer

The American Heart Association (AHA) Guidelines for Prevention of Infective Endocarditis were updated in 2007 and included numerous changes from the previous 1997 version. The guidelines were approved by the Council on Scientific Affairs of the American Dental Association as it relates to dentistry. Additionally, the guideline is endorsed by the Infectious Diseases Society of America. [1]

Major changes in the updated AHA guidelines include the following:

  • Only an extremely small number of cases of infective endocarditis (IE) might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective.
  • IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE.
  • For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.
  • Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis.
  • Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.

The antibiotic prophylactic regimens recommended by the AHA are only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. [1, 2]

High-risk cardiac conditions

Antibiotic prophylaxis is indicated for the following high-risk cardiac conditions:

  • Prosthetic cardiac valve, including transcatheter aortic valve replacement (TAVR) [3, 2]
  • Prosthetic material used for valve repair, ie, annuloplasty rings and chords [3]
  • Cardiac transplant with valve regurgitation due to a structurally abnormal valve [3]
  • Congenital heart disease (CHD) (except for the conditions listed below, antibiotic prophylaxis is no longer recommended for any other form of CHD): (1) Any type of cyanotic congenital heart disease; (2) Any congenital heart disease repaired with a prosthetic material placed surgically or percutaneously, up to 6 months after the procedure or lifelong if there is residual shunt or valvular regurgitation; (3) Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibits endothelialization)
  • Cardiac transplant recipients with cardiac valvular disease

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