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Prosthetic Valve Endocarditis After Aortic Valve Replacement: Differences Between Biological and Mechanical
Naomi Timmermans1, Ka Yan Lam1, Albert van Straten1
1Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Heart, Lung & Circulation
|December 29, 2023
Summary
Bioprosthetic aortic valves require re-intervention for prosthetic valve endocarditis (PVE) more often than mechanical valves. This study found biological valves were associated with a higher rate of PVE re-intervention.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis
- Prosthetic Valve Complications
Background:
- Prosthetic valve endocarditis (PVE) is a severe complication of infective endocarditis with high mortality.
- Controversy exists regarding whether biological and mechanical aortic valves are affected equally by PVE.
- This study addresses the comparative incidence of re-intervention for PVE between bioprosthetic and mechanical aortic valves.
Purpose of the Study:
- To compare the incidence of re-intervention due to PVE between bioprosthetic and mechanical aortic valves.
- To identify risk factors associated with re-intervention for PVE after aortic valve replacement (AVR).
Main Methods:
- Retrospective cohort study analyzing 5,983 patients undergoing AVR between January 1998 and December 2019.
- Patients requiring re-intervention for PVE were identified, with explant rates as the primary endpoint.
- Cox regression analysis, including competing risk correction, was used to analyze freedom from re-intervention and associated variables.
Main Results:
- The study included 3,620 biological and 2,363 mechanical aortic valve prostheses.
- The rate of re-intervention for PVE was 1.5% for biological valves and 1.7% for mechanical valves (p=0.541).
- Cox regression revealed younger age, male sex, higher creatinine, and biological valve prosthesis were associated with PVE re-intervention. After competing risk correction, biological valves showed a significantly higher rate of re-intervention for PVE (HR 2.011, p=0.011).
Conclusions:
- This single-center study suggests that AVR using biological prostheses is associated with a higher rate of re-intervention for PVE compared to mechanical prostheses.
- Further research is warranted to validate these findings in broader populations.
- Understanding these differences is crucial for optimizing patient selection and long-term management of prosthetic heart valves.
