Open AccessValvular Perforation in Left‐sided Native Valve Infective Endocarditis
Author(s) -
Bachour Khaled,
Zmily Hammam,
Kizilbash Mohammad,
Awad Khaled,
Hourani Rayan,
Hammad Hazem,
Sobel Jack D.,
Ghali Jalal K.,
Levine Donald,
Afonso Luis
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20499
Subject(s) - medicine , infective endocarditis , perforation , surgery , endocarditis , univariate analysis , cardiology , group b , aortic valve , hemodialysis , retrospective cohort study , mitral valve , valvular heart disease , multivariate analysis , materials science , punching , metallurgy
Background Left‐sided native valve infective endocarditis (LNVIE) can result in mitral (MP) and aortic (AP) valve perforation, the prognostic significance of which remains poorly defined. Hypothesis Valvular perforation is associated with worse outcomes. Methods Retrospective review of patients with LNVIE during 1998–2005 was performed to examine characteristics and outcome predictors of LNVIE complicated by valve perforation. Patients were stratified as: group A: MP or AP detected by transesophageal echocardiography (TEE) or surgery; group B: no TEE evidence of MP or AP. Results A total of 123 patients were included (group A = 47, group B = 76). In group A, 35 patients (74.5%) had MP alone, 11 (23.4%) had AP alone, and 1 patient had both. Severe valvular insufficiency was encountered more in group A (85.1% versus 59.2%, p = 0.003), so was hemodialysis (40.4% versus 17.1%, p = 0.004) and indications for valvular surgery (93.6% versus 77.6%, p = 0.02). Group A had a higher rate of in‐hospital death (31.9% versus 15.8%, p = 0.04). Among patients who had an indication for valvular surgery, the in‐hospital mortality rate for those who underwent valvular surgery was 16.7% in group A, and 7.9% in group B (p = 0.4), compared to those who did not undergo surgery (71.4% versus 33.3%, p = 0.04). Amongst survivors, hospital stay was on average 9.2 d longer in group A (38.9 versus 29.7 d, p = 0.05). Univariate analysis revealed association between lower survival and valvular perforation (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.17–0.95), that was lost after adjusting for hemodialysis. Conclusions Valve perforation complicating LNVIE is associated with hemodialysis, severe valvular insufficiency, and significant morbidity and mortality. Compared to conservative management, early surgical intervention is associated with improved survival. Copyright © 2009 Wiley Periodicals, Inc.