Infective Endocarditis in Bicuspid Aortic Valve: A Contemporary Review of Clinical Characteristics, Structural Complications, and Surgical Outcomes

Bicuspid aortic valve-associated infective endocarditis (BAV-IE) is a unique and aggressive type of native valve infection. The combined effects of congenital valve malformation, altered hemodynamics, and genetic susceptibility promote endothelial injury and bacterial colonization, predisposing affected individuals to serious infections. Compared with endocarditis in the tricuspid aortic valve, BAV-IE affects young patients with few comorbidities and causes more severe tissue damage, periannular abscesses, and necessitates early surgery. Notably, streptococci and staphylococci remain the predominant pathogens causing the disease. Multimodal imaging, which integrates transthoracic and transesophageal echocardiography into cardiac computed tomography, is crucial for the early detection of structural complications and surgical planning. Prompt surgical interventions, including radical debridement, valve replacement, and appropriate aortic repair, ensure optimal infection control and long-term outcomes. Moreover, long-term survival is favorable, regardless of infection severity, when managed promptly and comprehensively. Lifelong surveillance and preventive strategies focusing on oral hygiene, infection control, and procedural asepsis are critical for reducing recurrence and improving prognoses in this high-risk population.