Mechanical versus Biological Valve Prostheses for Infective Endocarditis Presenting with Stroke

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Innovation

Background:

• Infective endocarditis (IE) with stroke presents complex clinical challenges.
• Valve replacement is crucial, but prosthesis type impacts outcomes.

Purpose of the Study:

• To compare clinical outcomes of mechanical versus biological valve prostheses in IE patients with stroke.
• To assess the impact of prosthesis type on mortality, stroke recurrence, and re-infection.

Main Methods:

• Retrospective analysis of 95 adult patients with IE and stroke undergoing aortic/mitral valve replacement.
• Primary outcome: composite of mortality, ischemic/hemorrhagic stroke, and re-endocarditis.
• Secondary outcomes: individual components and modified Rankin Scale (mRS) deterioration.

Main Results:

• Mechanical valves (35.8%) were associated with a reduced composite outcome risk (aHR 0.46, p=0.037).
• Significantly lower re-endocarditis risk with mechanical valves (aHR 0.15, p=0.026).
• No increased risk of stroke or mortality with mechanical valves; trend towards decreased mRS deterioration (aOR 0.22, p=0.053).

Conclusions:

• Mechanical valve prostheses appear beneficial for IE patients with stroke, reducing composite adverse events.
• Mechanical valves show promise in lowering re-endocarditis and potentially improving functional outcomes.
• Larger studies are needed to confirm these findings and guide clinical practice.