Aortic and Mitral Valve Endocarditis-Simply Left-Sided Endocarditis or Different Entities Requiring Individual...

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Left-sided infective endocarditis (IE) often groups aortic valve IE (AV-IE) and mitral valve IE (MV-IE).
• Significant anatomical, physiological, and pathological differences exist between the aortic and mitral valves.
• These differences may influence patient characteristics, pathogen profiles, and clinical outcomes in IE.

Purpose of the Study:

• To compare patient demographics, causative pathogens, and surgical outcomes between AV-IE and MV-IE.
• To identify predictors of mortality in patients with isolated AV-IE or MV-IE.
• To evaluate the impact of valve specificity on long-term survival in left-sided IE.

Main Methods:

• Retrospective analysis of 3899 patients with isolated AV-IE or MV-IE from six German cardiac surgery centers (1994-2018).
• Univariable and multivariable analyses to assess risk factors for 30-day and 1-year mortality.
• Log-rank test for differences in long-term mortality.

Main Results:

• Mitral valve IE (MV-IE) patients were more frequently female and had higher rates of vegetation, cerebral embolic events, and stroke.
• Staphylococci were more prevalent in MV-IE. MV-IE had similar 30-day mortality but significantly higher 1-year mortality compared to AV-IE.
• Kaplan-Meier analysis revealed significantly lower long-term survival for MV-IE patients.

Conclusions:

• Aortic valve infective endocarditis (AV-IE) and mitral valve infective endocarditis (MV-IE) exhibit distinct clinical profiles and outcomes.
• Higher rates of embolic events and worse long-term survival in MV-IE underscore its unique challenges.
• Valve-specific guideline recommendations for left-sided IE are warranted to optimize patient management and outcomes.