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Comparative Surgical Outcomes of Prosthetic and Native Valve Endocarditis

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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 patient-years), 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.
Author(s)
주석중표원경김호진김준범정성호정철현이재원
Issued Date
2021
Type
Article
Keyword
EndocarditisCardiac valve prosthesisRecurrenceMortality
DOI
10.4070/kcj.2020.0448
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8769
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9794459&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Comparative%20Surgical%20Outcomes%20of%20Prosthetic%20and%20Native%20Valve%20Endocarditis&amp;offset=0&amp;pcAvailability=true
Publisher
KOREAN CIRCULATION JOURNAL
Location
대한민국
Language
영어
ISSN
1738-5520
Citation Volume
51
Citation Number
6
Citation Start Page
504
Citation End Page
514
Appears in Collections:
Medicine > Medicine
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