Key result
Valvular perforation in left-sided native valve infective endocarditis was associated with higher in-hospital mortality (31.9% vs 15.8%, p=0.04), but this was lost after adjusting for hemodialysis.
Why the study?
Does valvular perforation worsen outcomes in patients with left-sided native valve infective endocarditis?
Observational (n=123)
Does valvular perforation worsen outcomes in patients with left-sided native valve infective endocarditis?
Odds Ratio: 0.4 (95% CI 0.17–0.95)
Absolute Event Rate: 31.9% vs 15.8%
p-value: p=0.04
Valvular perforation in left-sided native valve infective endocarditis is associated with severe valvular insufficiency, hemodialysis, and higher in-hospital mortality, highlighting the importance of early surgical intervention.
Mortality association is confounded by hemodialysis; leaves open whether perforation independently worsens prognosis in left-sided native valve IE.
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.
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Bachour et al. (2009) conducted an observational in Left-sided native valve infective endocarditis (n=123). Valvular perforation vs. No transesophageal echocardiography evidence of valvular perforation was evaluated on In-hospital death (OR 0.4, 95% CI 0.17-0.95, p=0.04). Valvular perforation in left-sided native valve infective endocarditis was associated with higher in-hospital mortality (31.9% vs 15.8%, p=0.04), but this was lost after adjusting for hemodialysis.
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