Korean Circ J.  2021 Jun;51(6):504-514. 10.4070/kcj.2020.0448.

Comparative Surgical Outcomes of Prosthetic and Native Valve Endocarditis

• Pyo WK
• Kim HJ
• Kim JB
• Jung SH
• Choo SJ
• Chung CH
• Lee JW

• KMID: 2516211
• DOI: http://doi.org/10.4070/kcj.2020.0448

Abstract

Background and Objectives
As a consequence of a growing number of patients undergoing prosthetic heart valve replacement, the incidence of prosthetic valve endocarditis (PVE) has increased. The study aims to analyze patterns and outcomes of PVE surgery as compared with native valve endocarditis (NVE).
Methods
We enrolled 269 patients (aged 58.0±15.7 years) who underwent valve surgery for infective endocarditis (IE) between 2013 and 2019. Of these, 56 had PVE whereas remainder (n=213) had NVE. Clinical outcomes were compared and multivariable analyses were conducted to determine risk factors for mortality.
Results
The proportion of PVE among surgical IE gradually increased from 15.4% (11/71) in the first time-quartile to 29.5% (18/61) in the last time-quartile (p=0.055). PVE patients were older, and more commonly had aorto-mitral curtain involvement and abscess formation than NVE group. Early mortality was 14.3% and 6.1% in PVE and NVE group, respectively (p=0.049). Postoperatively, PVE group had higher incidences of low cardiac output syndrome (p=0.027), new-onset dialysis (p=0.006) and reoperation for bleeding (p=0.004) compared to NVE group, but stroke rates were comparable (p=0.503). During follow-up (648.8 patientyears), PVE group showed significantly higher risks of overall mortality (p<0.001), valve reinfection (p<0.001) and permanent pacemaker implantation (p<0.001) than NVE group. On multivariable analysis, PVE (hazard ratio, 2.67; 95% confidence interval, 1.40–5.07; p=0.003) along with age, chronic kidney disease, multi-valve involvement, and causative organisms of Staphylococcus aureus or fungus were independent risk factors of overall mortality.
Conclusions
PVE carried significant perioperative risks, and was an independent risk factor of overall mortality.

Keyword

Endocarditis; Cardiac valve prosthesis; Recurrence; Mortality

Figure

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  Figure 1 Quartile trends in proportion of prosthetic valve endocarditis among surgical patients with infective endocarditis over time.NVE = native valve endocarditis; PVE = prosthetic valve endocarditis.

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  Figure 2 Kaplan-Meier curves for the clinical outcomes. (A) Kaplan-Meier curve for the survival rates. (B) Kaplan-Meier curve for freedom from IE recurrence rates. (C) Kaplan-Meier curve for freedom from stroke rates. (D) Kaplan-Meier curve for freedom from PPM plantation.IE = infective endocarditis; PPM = permanent pacemaker.

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