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Incidence and risk factors of prosthetic valve endocarditis
Unlabelled:
To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacements from 1 January 1981 to 31 December 1985 for 1-6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): chi-square = 6.1, P less than 0.025. PVE developed in 19 of 329 patients with bioprostheses (5.8%), and in 8 of 583 patients with mechanical valves (1.4%): chi-square = 14.48, P less than 0.005). Actuarially at 5-year follow-up, 90.7% +/- 2.16% of the bioprosthetic group and 98.4% +/- 0.56% of the mechanical valve group was free of PVE (P less than 0.001). Antecedent endocarditis increased both the incidence and relative risk of PVE 7-fold compared to patients without antecedent endocarditis (chi-square = 32.0, P less than 0.0001). Bioprosthetic valve replacement in infective endocarditis increased the risk of PVE 12-fold compared to valve replacement by mechanical prostheses.
In Conclusion:
in the order of importance, antecedent endocarditis, bioprostheses and aortic position are risk factors in the development of PVE. Bioprostheses implanted in patients with antecedent endocarditis further enhance the risk of PVE.
Insights
Prosthetic valve endocarditis (PVE) is more common with bioprosthetic valves and in the aortic position. Prior endocarditis significantly increases PVE risk, especially with bioprosthetic valves.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Prosthetic valve endocarditis (PVE) is a serious complication following valve replacement surgery.
- Identifying risk factors is crucial for preventing PVE and improving patient outcomes.
Purpose of the Study:
- To determine the incidence and identify key risk factors for prosthetic valve endocarditis (PVE).
- To compare PVE rates between different valve types and positions, and assess the impact of prior endocarditis.
Main Methods:
- A cohort study followed 912 patients who underwent valve replacement between 1981 and 1985.
- Data collected included valve type (bioprosthetic vs. mechanical), valve position (aortic vs. mitral), and history of endocarditis.
- Incidence rates and risk factors for PVE were analyzed using statistical methods, including chi-square tests and actuarial analysis.
Main Results:
- The overall incidence of PVE was 2.96% (0.98% per patient-year).
- Aortic position (3.9%) had a significantly higher PVE incidence than mitral position (1.5%).
- Bioprosthetic valves (5.8%) showed a higher incidence of PVE compared to mechanical valves (1.4%).
- Actuarial 5-year follow-up revealed significantly higher PVE-free rates for mechanical valves (98.4%) versus bioprosthetic valves (90.7%).
- Antecedent endocarditis increased PVE incidence and relative risk sevenfold.
- Bioprosthetic valve replacement in patients with prior endocarditis elevated PVE risk twelvefold compared to mechanical valves.
Conclusions:
- Antecedent endocarditis, bioprosthetic valves, and aortic valve position are significant risk factors for PVE.
- The combination of bioprosthetic valves and a history of endocarditis dramatically increases the risk of developing PVE.