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Surgical aortic valve replacement and infective endocarditis
Author(s) -
Malmberg Markus,
Ahtela Elina,
Sipilä Jussi O. T.,
Gunn Jarmo,
Rautava Päivi,
Kytö Ville
Publication year - 2021
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13476
Subject(s) - medicine , aortic valve replacement , infective endocarditis , stroke (engine) , cardiology , hazard ratio , endocarditis , aortic valve , cohort , surgery , confidence interval , stenosis , mechanical engineering , engineering
Background We wanted to investigate the influence of native‐valve infective endocarditis (IE) on long‐term outcomes of surgical aortic valve replacement (SAVR). Methods Native‐valve patients with IE (n = 191) were compared to propensity score‐matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population‐based cohort register study in Finland. The median follow‐up was 6.2 years. Results Infective endocarditis as the indication for SAVR was associated with an increased hazard of 10‐year mortality (37.1% vs 24.2%; HR 1.83; CI 1.03‐3.26; P = .039). Ischaemic stroke was also more frequent in IE patients during 10‐year follow‐up (15.8% vs 7.5%; HR 3.80; CI 1.42‐10.18; P = .008). Major bleeding within first year after SAVR was more frequent in patients with IE (7.0% vs 2.9%; P = .038). Ten‐year major bleeding rate was 32.4% in IE vs 24.5% in non‐IE groups ( P = .174). Aortic valve re‐operation rate was 4.3% in IE vs 8.4% in non‐IE groups ( P = .975). Admission duration after SAVR was longer in IE (median 29 vs 9 days; P < .0001). There was no difference in 30‐day mortality after SAVR. Conclusions Patients with native‐valve IE have a higher risk of death, ischaemic stroke, and early major bleeding after SAVR than matched patients without IE. Results confirm the high risk for complications of IE patients after SAVR and highlight the importance of vigorous prevention of both stroke and bleeding after SAVR in these patients.