Kiyota Yuka, Della Corte Alessandro, Montiero Vieira Vanessa, Habchi Karam, Huang Chuan-Chin, Della Ratta Ester E, Sundt Thoralf M, Shekar Prem, Muehlschlegel Jochen D, Body Simon C
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Cardiothoracic Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
Open Heart. 2017 May 16;4(1):e000545. doi: 10.1136/openhrt-2016-000545. eCollection 2017.
Patients with structural abnormalities of cardiac valves, including bicuspid aortic valve (BAV), are said to be at higher risk of infective endocarditis (IE). We sought to determine the risk of IE of the BAV compared with the tricuspid aortic valve (TAV) and to determine the risk of aortic valve replacement and mortality after IE.
From medical records of two US and one Italian hospitals, patients with their first episode of IE of any native valve were identified. In the US cohort 42 patients with BAV and 393 patients with TAV with IE occurring between 1 January 2000 and 30 June 2014 were identified. In the Italian cohort 48 patients with BAV and 341 patients with TAV with IE underwent valve replacement surgery between 1 January 2000 and1 November 2015. The risk of IE for BAV and TAV and subsequent outcomes were determined after matching to patients without IE.
After adjustment for risk factors, the risk of IE in the US cohort was 23.1 (95% CI 8.1 to 100, p <0.0001) times greater for BAV than TAV. Patients with BAV with IE were more likely to have an aortic root abscess. Within the subsequent 5 years, BAV patients with IE were more likely to undergo valve replacement (85%) than TAV patients with IE (46%). Patients with IE were at increased risk of death. The findings were similar in the Italian cohort.
Patients with BAV are at markedly increased risk of IE and aortic root abscess than patients with TAV. Increased risk of IE in patients with BAV indicates they may be a candidate group for long-term trials of antibiotic prophylaxis of IE.
心脏瓣膜结构异常的患者，包括二叶式主动脉瓣（BAV）患者，据说感染性心内膜炎（IE）风险更高。我们试图确定BAV与三叶式主动脉瓣（TAV）相比的IE风险，并确定IE后的主动脉瓣置换风险和死亡率。
从两家美国医院和一家意大利医院的病历中，识别出首次发生任何天然瓣膜IE的患者。在美国队列中，识别出2000年1月1日至2014年6月30日期间发生IE的42例BAV患者和393例TAV患者。在意大利队列中，2000年1月1日至2015年11月1日期间，48例BAV合并IE患者和341例TAV合并IE患者接受了瓣膜置换手术。在与无IE患者匹配后，确定BAV和TAV的IE风险及后续结局。
在调整风险因素后，美国队列中BAV发生IE的风险是TAV的23.1倍（95%CI 8.1至100，p<0.0001）。BAV合并IE的患者更易发生主动脉根部脓肿。在随后5年内，BAV合并IE的患者比TAV合并IE的患者更易接受瓣膜置换（85%比46%）。IE患者死亡风险增加。意大利队列中的结果相似。
与TAV患者相比，BAV患者发生IE和主动脉根部脓肿的风险显著增加。BAV患者IE风险增加表明他们可能是IE抗生素预防长期试验的候选人群。
