Infective Endocarditits After Left-Sided Valve Replacement

Study Questions:

What is the incidence and what are the risk factors for infective endocarditis (IE) among patients who underwent prior left-sided heart valve replacement?

Methods:

Through Danish administrative registries, patients were identified who underwent left-sided heart valve replacement from January 1996 to December 2015. Patients were categorized as mitral or aortic valve replacement (MVR or AVR), and followed until the first of: 12 years after valve surgery, end of study, death, emigration, or hospitalization due to IE. Multivariable adjusted Cox proportional hazard analysis was used to investigate which baseline characteristics were associated with IE.

Results:

A total of 18,041 patients were included. The cumulative IE risk at 10-year follow-up was 5.2% in both MVR and AVR patients. Among patients following MVR, male sex (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.06-2.68), bioprosthetic valve (HR, 1.91; 95% CI, 1.08-3.37), and heart failure (HR, 1.69; 95% CI, 1.06-2.68) were among factors associated with an increased risk of IE. Among patients following AVR, male sex (HR, 1.59; 95% CI, 1.33-1.89), bioprosthetic valve (HR, 1.70; 95% CI, 1.35-2.15), and cardiac implantable electronic device (CIED; HR, 1.57; 95% CI, 1.19-2.06) were among factors associated with an increased risk of IE.

Conclusions:

IE after left-sided heart valve replacement is not uncommon, and occurs in about 1 of 20 patients over 10 years. Male sex, bioprosthetic valve, and heart failure were among factors associated with IE among patients after MVR; while male sex, bioprosthetic valve, and CIED were among factors associated with IE among patients following AVR.

Perspective:

Data from this study suggest that IE is not uncommon after left-sided heart valve replacement. An unexpected finding is that a bioprosthesis was found to be a risk factor for IE among patients after both AVR and MVR. Although not the only study to suggest this, data from this retrospective study still should be interpreted with some caution.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Aortic Valve, Bioprosthesis, Cardiac Surgical Procedures, Defibrillators, Implantable, Endocarditis, Endocarditis, Bacterial, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Incidence, Mitral Valve, Risk Factors, Secondary Prevention, Transcatheter Aortic Valve Replacement


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