Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Division of General Cardiology, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Heart Vessels. 2022 May;37(5):895-901. doi: 10.1007/s00380-021-01980-2. Epub 2021 Nov 5.
Most cases of infective endocarditis (IE) involve a single valve, and little is known concerning IE that simultaneously affects two valves. The involvement of more than one valve may imply more severe and extensive cardiac lesions. In these patients, surgery may be challenging. We aimed to determine the clinical characteristics, the therapeutic strategy, and the prognostic impact of double-valve IE (DVIE). We retrospectively included in the analysis that 440 consecutive patients with definite active IE in a single surgical centre. DVIE occurred in 75 of the total enrolled 440 patients (17%) and involved mostly the combination of mitral and aortic valves (N = 63, 84%). Most patients had double-native IE (N = 45, 60%). Staphylococci were less frequent in patients with double-valve than single-valve IE (SVIE). The proportion of patients undergoing valve repair among those treated surgically was higher for patients with DVIE than for SVIE (p < 0.03). Valve repair of at least one valve was associated with non-significant better survival than double replacement. DVIE was associated with higher all-cause mortality than SVIE (p < 0.013) and a higher relapse rate (p = 0.023). DVIE was not associated with a higher risk of composite non-fatal adverse events. DVIE represents a considerable proportion of overall cases of IE, mainly involving aortic and mitral valves, with a jet lesion on the mitral valve; Staphylococcus is significantly less frequent than in SVIE; DVIE is independently associated with higher mortality and relapse rate; finally, mitral valve repair is feasible in a considerable proportion of surgical cases.
大多数感染性心内膜炎（IE）病例涉及单个瓣膜，而同时影响两个瓣膜的 IE 知之甚少。超过一个瓣膜的受累可能意味着更严重和广泛的心脏病变。在这些患者中，手术可能具有挑战性。我们旨在确定双瓣膜 IE（DVIE）的临床特征、治疗策略和预后影响。我们回顾性地分析了单一手术中心连续 440 例确诊活动性 IE 患者，其中 75 例（17%）为双瓣膜 IE，主要涉及二尖瓣和主动脉瓣的组合（N=63，84%）。大多数患者为双原发瓣膜 IE（N=45，60%）。与单瓣膜 IE（SVIE）相比，双瓣膜 IE 患者中葡萄球菌较少。接受手术治疗的患者中，行瓣膜修复术的比例在双瓣膜 IE 患者中高于 SVIE 患者（p<0.03）。至少修复一个瓣膜与双瓣膜置换术相比，生存率非显著提高。与 SVIE 相比，DVIE 与更高的全因死亡率（p<0.013）和更高的复发率（p=0.023）相关。DVIE 与复合非致命不良事件的风险增加无关。DVIE 占 IE 总病例的相当大比例，主要涉及主动脉瓣和二尖瓣，二尖瓣上有射流病变；与 SVIE 相比，金黄色葡萄球菌明显较少；DVIE 与更高的死亡率和复发率独立相关；最后，二尖瓣修复术在相当一部分手术病例中是可行的。
