Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Clin Res Cardiol. 2020 Nov;109(11):1342-1351. doi: 10.1007/s00392-020-01628-7. Epub 2020 Mar 17.
Infective endocarditis (IE) may require heart valve surgery. It is well known that heart valve surgery itself and previous IE predispose to IE. However, data are sparse on whether the risk of IE is different among patients undergoing valve surgery due to IE and other causes (i.e. recurrent vs. first-time IE).
Using Danish nationwide registries, patients undergoing left-sided heart valve surgery in the course of an IE hospitalization (1996-2017) were identified and matched with controls undergoing left-sided heart valve surgery due to another cause than IE in a 1:1 ratio. Patients were stratified according to type of surgical valve intervention and affected valve. The comparative risk of recurrent vs. first-time IE was assessed by cumulative incidence curves and multivariable Cox regression analyses.
The study population comprised 971 patients with a first-time admission for IE requiring heart valve surgery matched with 971 controls undergoing heart valve surgery due to other causes than IE. The risk of recurrent IE was significantly higher than the risk of first-time IE following heart valve surgery (5.5% and 3.0% by 10 years, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.02-2.70). The risk of IE recurrence was not significantly different comparing valve replacement and valve repair (5.5% and 5.3%, respectively, HR 1.60, 95% CI 0.71-3.60). Yet, the risk of IE recurrence was significantly higher among patients with biological versus mechanical prostheses (6.3% and 4.6%, respectively, HR 2.00, 95% CI 1.02-3.70).
Following heart valve surgery, the risk of recurrent IE was significantly higher than the risk of first-time IE.
感染性心内膜炎（IE）可能需要心脏瓣膜手术。众所周知，心脏瓣膜手术本身以及先前的 IE 会增加 IE 的发病风险。然而，关于因 IE 和其他原因（即复发性与首次 IE）而接受瓣膜手术的患者，IE 的风险是否不同，相关数据却很少。
利用丹麦全国性登记处，确定在 IE 住院期间接受左侧心脏瓣膜手术的患者，并按 1:1 的比例与因 IE 以外的其他原因接受左侧心脏瓣膜手术的对照组相匹配。根据手术瓣膜干预类型和受影响的瓣膜对患者进行分层。通过累积发病率曲线和多变量 Cox 回归分析评估复发性 IE 与首次 IE 的相对风险。
该研究人群包括 971 例首次因 IE 需行心脏瓣膜手术的患者，与 971 例因 IE 以外的其他原因而行心脏瓣膜手术的对照组相匹配。与心脏瓣膜手术后首次 IE 相比，心脏瓣膜手术后复发性 IE 的风险显著更高（10 年时分别为 5.5%和 3.0%，风险比 (HR) 1.66，95%置信区间 (CI) 1.02-2.70）。瓣膜置换术和瓣膜修复术的 IE 复发风险无显著差异（分别为 5.5%和 5.3%，HR 1.60，95% CI 0.71-3.60）。然而，生物假体与机械假体的 IE 复发风险存在显著差异（分别为 6.3%和 4.6%，HR 2.00，95% CI 1.02-3.70）。
心脏瓣膜手术后，复发性 IE 的风险显著高于首次 IE 的风险。
