Aortic valve endocarditis in patients with bicuspid and tricuspid aortic valvesCentral MessagePerspective

JTCVS Open

Jeffrey Clemence, Jr., BS¹  Xiaoting Wu, PhD¹  Himanshu J. Patel, MD¹  G. Michael Deeb, MD¹  Karen M. Kim, MD¹  Bo Yang, MD, PhD¹  Aroma Naeem, BA¹  Tan Le, BS¹  Nathan J. Graham, BS²  Juan Caceres, BS² 

[1] Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich;University of Michigan Medical School, Ann Arbor, Mich;

关键词: bicuspid aortic valve;    aortic valve;    endocarditis;    aortic valve replacement;    reoperation;    survival;   

DOI  :  

来源: DOAJ

【 摘 要 】

Objective: To determine the long-term survival and rate of reoperation after surgical treatment of infective endocarditis (IE) in patients with a bicuspid aortic valve (BAV) and patients with a tricuspid aortic valve (TAV). Methods: Between 1997 and 2017, 210 patients underwent surgical treatment for native aortic valve endocarditis, including 51 patients with BAV (24%) and 159 patients with TAV (76%). Data were obtained from the Society of Thoracic Surgeons data warehouse and hospital medical record review, supplemented with surveys and national death index data for more complete follow-up. Results: Compared with the TAV IE group, the BAV IE group was significantly younger (42 years vs 54 years) and had lower incidence rates of hypertension, coronary artery disease, and congestive heart failure (CHF). There were no significant between-group differences in postoperative stroke, sepsis, pacemaker requirement, or in-hospital mortality (2.0% vs 4.4%). Liver disease was a risk factor for operative mortality (odds ratio [OR], 13; 95% CI, 3.3-30; P = .0002). The 10-year survival rate was 64% for the BAV group versus 46% for the TAV group (P = .0191). Significant risk factors for long-term mortality were intravenous drug use (hazard ratio [HR], 4.5; P < .0001), preoperative renal failure requiring dialysis (HR, 4.13; P < .0001), CHF (HR, 1.7; P = .04), and liver disease (HR, 2.6; P = .02). The HR for BAV was 0.67 (95% confidence interval [CI], 0.3-1.4). The 10-year postoperative cumulative incidence of reoperation was significantly higher in the BAV patients compared with the TAV patients (5.7% vs 4.5%; P = .045) with an HR of 2.4 (95% CI, 0.8-7.1; P = .11) for BAV. Conclusions: BAV patients develop IE requiring surgery at a younger age than TAV patients, but have significantly better long-term survival. Early detection of BAV is important to prevent IE and provide aggressive surgical treatment should IE occur.

【 授权许可】

Unknown