ESC recommendations for high risk patients
ESC recommendations for high risk patients
The recommendations related to antibiotic prophylaxis in high risk patients with cardiovascular diseases undergoing dental procedures from the 2023 European Society of Cardiology guideline19 are presented below.
Note that the wording of each recommendation reflects the level of evidence and/or consensus and the class of recommendation.
| Recommendation | Class of recommendation* | Level of evidence¥ |
| Antibiotic prophylaxis is recommended in patients with a previous episode of infective endocarditis | Class I | B |
| Antibiotic prophylaxis is recommended in patients with surgically implanted prosthetic valves and with any material used for surgical cardiac valve repair | Class I | C |
| Antibiotic prophylaxis is recommended in patients with transcatheter implanted aortic and pulmonary valvular prostheses | Class I | C |
| Antibiotic prophylaxis is recommended in patients with untreated cyanotic congenital heart disease (CHD), and patients treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits or other prostheses. After surgical repair, in the absence of residual defects or valve prostheses, antibiotic prophylaxis is recommended only for the first 6 months after the procedure |
Class I | C |
| Antibiotic prophylaxis is recommended in patients with ventricular assist devices | Class I | C |
| Antibiotic prophylaxis should be considered in patients with transcatheter mitral and tricuspid valve repair. Patients with septal defect closure devices, left atrial appendage closure devices, vascular grafts, vena cava filters, and central venous system ventriculo-atrial shunts are considered within this risk category in the first 6 months after implantation. |
Class IIa | C |
| Antibiotic prophylaxis may be considered in recipients of heart transplant | Class IIb | C |
*Class of recommendation
Class I: evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective;
Class II: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure;
Class IIa: Weight of evidence/opinion is in favour of usefulness/efficacy;
Class IIb: Usefulness/efficacy is less well established by evidence/opinion.
¥ Level of evidence
Level of evidence B: Data derived from a single randomised clinical trial or large non-randomised studies
Level of evidence C: Consensus of opinion of the experts and/or small studies, retrospective studies, registries
Reproduced from the 2023 ESC Guidelines for the management of endocarditis.19