One-year outcome following biological or mechanical valve replacement for infective endocarditis

Francois Delahaye, Vivian Chu, Javier Altclas, Bruno Barsic, A Delahaye, T Freiberger, David Gordon, Margaret Hannan, Bruno Hoen, S Kanj, Tatjana Lejko-Zupanc, CA Mestres, Orathai Pachirat, Paul Pappas, C Lamas, Christine Selton-Suty, R Tan, Pierre Tattevin, Andrew Wang

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    19 Citations (Scopus)

    Abstract

    Background Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality.

    Methods and results Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54 years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p = 0.0009) and 25.3% vs 16.6% (p <.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298).

    Conclusions Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.

    Original languageEnglish
    Pages (from-to)117-123
    Number of pages7
    JournalInternational Journal of Cardiology
    Volume178
    DOIs
    Publication statusPublished - 15 Jan 2015

    Keywords

    • Infective endocarditis
    • Surgery
    • Valve prosthesis

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