Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis-A...

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Infective endocarditis (IE) is a severe complication, with prosthetic valve endocarditis (PVE) accounting for a significant portion and high mortality.
• Understanding the differences between biological and mechanical PVE is crucial for patient management and outcomes.

Purpose of the Study:

• To compare baseline characteristics, microbiology, clinical presentation, complications, and prognosis between biological PVE (bPVE) and mechanical PVE (mPVE).
• To conduct a subgroup analysis for patients aged 45-65 undergoing prosthetic surgery.

Main Methods:

• Post hoc analysis of a prospective multicenter cohort of PVE patients (January 2008 - December 2023).
• Patients were categorized into mechanical PVE (mPVE) and biological PVE (bPVE) groups.
• Multivariable logistic regression was used to identify mortality risk factors.

Main Results:

• bPVE presented earlier than mPVE and had more healthcare-associated infections and paravalvular issues.
• mPVE showed a higher incidence of Staphylococcus aureus and Gram-negative bacteria, while bPVE had more coagulase-negative staphylococci.
• Independent mortality risk factors included EuroSCORE I, age, mPVE, S. aureus, multi-valve IE, and severe sepsis. mPVE had higher in-hospital mortality, linked to septic shock and CNS embolism.

Conclusions:

• bPVE occurs earlier than mPVE, even in the 45-65 age group, and is associated with increased healthcare-related infections and paravalvular complications.
• Despite differences in presentation and complications, mPVE demonstrated higher in-hospital mortality after adjusting for baseline factors.