Bohbot Yohann, Peugnet Fanny, Lieu Audrey, Carbone Andreina, Mouhat Basile, Philip Mary, Gouriet Frederique, Arregle Florent, Chevalier Florent, Diouf Momar, Rusinaru Dan, Habib Gilbert, Tribouilloy Christophe
Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
Department of Cardiology, Amiens University Hospital, Amiens, France.
Can J Cardiol. 2021 Feb;37(2):292-299. doi: 10.1016/j.cjca.2020.03.046. Epub 2020 Apr 9.
Most cases of left-sided native valve infective endocarditis (IE) involve a single valve and little is known concerning IE that simultaneously affects the aortic and mitral valves.
We aimed to determine the characteristics, identify the prognostic factors, and define the effect of early surgery for patients with left-sided native bivalvular IE. This analysis included 1340 consecutive patients who presented with definite acute left-sided native valve IE in a 2-centre cohort study.
A bivalvular involvement was present in 257 patients (19%). Patients with bivalvular IE had more embolic events (P = 0.044), congestive heart failure (P = 0.016), vegetations, and perivalvular complications (both P < 0.001) than those with monovalvular IE. Early surgery was more frequent for patients with bivalvular IE (P < 0.001). Thirty-day mortality was higher for patients with bivalvular IE than for those with monovalvular IE (24.5% vs 17.6%; P = 0.008), even after adjustment (odds ratio, 1.86 [95% confidence interval, 1.26-2.73]; P < 0.001). Estimated 10-year survival was 70% ± 1% for monovalvular IE and 59% ± 3% for bivalvular IE (P = 0.002). Bivalvular IE was still associated with mortality in multivariable Cox analysis, after adjustment for covariates including age, neurological events, congestive heart failure, Staphylococcus spp infection, perivalvular complications, and early surgery (hazard ratio, 1.70 [95% confidence interval, 1.31-2.11]; P < 0.001). Early surgery was associated with increased survival for patients with bivalvular IE (79% ± 4% vs 35% ± 6%; P < 0.001).
Bivalvular involvement is frequent in left-sided native valve IE, is associated with more embolic events and congestive heart failure than monovalvular IE, and patients are at a high risk of death. Early surgery is associated with improved survival and should be systematically discussed in the absence of contraindication.
大多数左侧自体瓣膜感染性心内膜炎（IE）病例累及单个瓣膜，而关于同时累及主动脉瓣和二尖瓣的IE的情况知之甚少。
我们旨在确定左侧自体双瓣膜IE患者的特征，识别预后因素，并明确早期手术的效果。该分析纳入了一项2中心队列研究中1340例连续出现明确急性左侧自体瓣膜IE的患者。
257例患者（19%）存在双瓣膜受累。与单瓣膜IE患者相比，双瓣膜IE患者有更多的栓塞事件（P = 0.044）、充血性心力衰竭（P = 0.016）、赘生物和瓣周并发症（均P < 0.001）。双瓣膜IE患者早期手术更为频繁（P < 0.001）。双瓣膜IE患者的30天死亡率高于单瓣膜IE患者（24.5%对17.6%；P = 0.008），即使在调整后（比值比，1.86[95%置信区间，1.26 - 2.73]；P < 0.001）。单瓣膜IE的估计10年生存率为70%±1%，双瓣膜IE为59%±3%（P = 0.002）。在多变量Cox分析中，在调整了包括年龄、神经系统事件、充血性心力衰竭、葡萄球菌属感染、瓣周并发症和早期手术等协变量后，双瓣膜IE仍与死亡率相关（风险比，1.70[95%置信区间，1.31 - 2.11]；P < 0.001）。早期手术与双瓣膜IE患者生存率提高相关（79%±4%对35%±6%；P < 0.001）。
左侧自体瓣膜IE中双瓣膜受累很常见，与单瓣膜IE相比，有更多的栓塞事件和充血性心力衰竭，且患者死亡风险高。早期手术与生存率提高相关，在无禁忌证的情况下应进行系统讨论。
