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Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery
Eva Havers-Borgersen1, Jawad H Butt2, Lauge Østergaard2
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. evaborgersen@gmail.com.
Summary
Patients undergoing heart valve surgery face a higher risk of recurrent infective endocarditis (IE) compared to first-time IE. This increased risk is particularly notable with biological prostheses.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious heart infection.
- Heart valve surgery is a common treatment for IE, but also a risk factor for future IE.
- Previous IE and heart valve surgery increase the risk of subsequent IE, but comparative risks are unclear.
Purpose of the Study:
- To compare the risk of recurrent versus first-time infective endocarditis (IE) after left-sided heart valve surgery.
- To investigate if the risk of IE differs between patients undergoing valve surgery for IE versus other causes.
Main Methods:
- Nationwide Danish registry data (1996-2017) were used.
- Patients undergoing left-sided heart valve surgery during IE hospitalization were matched 1:1 with controls undergoing surgery for non-IE causes.
- Comparative risk of recurrent vs. first-time IE was assessed using cumulative incidence and Cox regression.
Main Results:
- The study included 971 IE patients and 971 controls.
- The cumulative incidence of recurrent IE was 5.5% at 10 years, significantly higher than first-time IE (3.0%), with a Hazard Ratio (HR) of 1.66.
- Recurrent IE risk was higher with biological prostheses (6.3%) compared to mechanical (4.6%), HR 2.00.
Conclusions:
- The risk of recurrent infective endocarditis (IE) is significantly higher after heart valve surgery than the risk of first-time IE.
- Valve replacement and repair showed similar recurrence risks, but biological prostheses were associated with higher IE recurrence rates.
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