Key result
Pre-operative native mitral valve infective endocarditis increased 10-year mortality after mitral valve replacement compared to non-IE patients (38.8% vs 30.5%; HR 2.13; 95% CI 1.17-3.85; P=0.013).
Why the study?
Long-term outcomes of mitral valve replacement in native mitral valve infective endocarditis required investigation.
Does native mitral valve infective endocarditis increase the risk of mortality and complications in adult patients undergoing first-time mitral valve replacement compared to non-IE indications?
Cohort (n=1,233)
Yes
Does native mitral valve infective endocarditis increase the risk of mortality and complications in adult patients undergoing first-time mitral valve replacement compared to non-IE indications?
Native mitral valve infective endocarditis is associated with significantly higher 10-year mortality and major bleeding following mitral valve replacement compared to non-IE indications.
Supports closer long-term follow-up after MVR in native mitral IE; leaves open whether targeted strategies mitigate excess risk.
BACKGROUND: We investigated the long-term outcomes of mitral valve replacement (MVR) in native mitral valve infective endocarditis (IE). METHODS: Multicentre, population-based cohort register study consisted of 1233 consecutive adult patients treated with first-time MVR in Finland. Mitral valve IE was diagnosed in 170 of these patients. Propensity score matching resulted in 134 pairs with balanced baseline characteristics. The median follow-up was 6.1 years. RESULTS: Pre-operative native mitral valve IE was associated with an increased hazard of 10-year mortality (38.8% vs 30.5%; HR 2.13; CI 1.17-3.85; P = .013) after MVR. Occurrence of major bleeding was higher in IE patients (26.0%) vs non-IE patients (23.4%) during the 10-year follow-up (HR 2.80; CI 1.01-7.77; P = .048). Hospital admission duration after MVR was longer in IE patients (median 28 vs 11 days; P < .0001). Cumulative ischaemic stroke rate was similar between patient groups (12.1% in IE vs 15.1% in non-IE; P = .493). Re-sternotomy was performed in 13.4% of IE patients and 9.0% of non-IE patients (P = .261). CONCLUSIONS: Patients with native mitral valve IE have a higher risk of death and major bleeding after MVR than matched patients without IE. Results highlight the importance of complication prevention in these patients.
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Anttila et al. (2021) conducted a cohort in Native mitral valve infective endocarditis (n=1,233). Native mitral valve infective endocarditis vs. No infective endocarditis was evaluated on 10-year mortality (HR 2.13, 95% CI 1.17-3.85, p=0.013). Pre-operative native mitral valve infective endocarditis increased 10-year mortality after mitral valve replacement compared to non-IE patients (38.8% vs 30.5%; HR 2.13; 95% CI 1.17-3.85; P=0.013).
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