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

Carolyn Weber1, Mateo Marin-Cuartas2, Sems-Malte Tugtekin3

  • 1Department of Cardiothoracic Surgery, University of Cologne, 50937 Cologne, Germany.

Journal of Clinical Medicine
|October 16, 2024
PubMed

Insights

Aortic valve infective endocarditis (AV-IE) and mitral valve infective endocarditis (MV-IE) differ significantly. MV-IE patients experienced more embolic events and higher long-term mortality, suggesting valve-specific treatment guidelines are needed.

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.

Keywords:
IEaortic valvecardiac surgeryinfective endocarditisleft-sided IEmitral valvevalve surgery

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