Bohbot Yohann, Denev Seyhan, Benvenga Rossella M, Philip Mary, Michelena Hector I, Citro Rodolfo, Habib Gilbert, Tribouilloy Christophe
Department of Cardiology, Amiens University Hospital, Amiens, France.
UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
Front Cardiovasc Med. 2023 Dec 14;10:1304957. doi: 10.3389/fcvm.2023.1304957. eCollection 2023.
Bicuspid aortic valve (BAV) is the most common congenital heart disease with an increased risk of infective endocarditis (IE). Few data are available on isolated native BAV-IE. The aim of this study was to compare patients with tricuspid aortic valve (TAV) IE and BAV-IE in terms of characteristics, management and prognosis.
We included 728 consecutive patients with IE on isolated native aortic valve in 3 centres: Amiens and Marseille Hospitals in France and Salerno Hospital in Italy. We studied in hospital and long-term mortality before and after matching for age, sex and comorbidity index. Median follow-up was 67.2 [IQR: 19-120] months.
Of the 728 patients, 123 (16.9%) had BAV. Compared with patients with TAV-IE, patients with BAV-IE were younger, had fewer co-morbidities and were more likely to be male. They presented more major neurological events and perivalvular complications (both < 0.05). Early surgery (<30 days) was performed in 52% of BAV-IE cases vs. 42.8% for TAV-IE ( = 0.061). The 10-year survival rate was 74 ± 5% in BAV-IE patients compared with 66 ± 2% in TAV-IE patients ( = 0.047). After propensity score matching (for age, gender and comorbidities), there was no difference in mortality between the two groups, with an estimated 10-year survival of 73 ± 5% vs. 76 ± 4% respectively ( = 0.91).
BAV is a frequent finding in patients with isolated aortic valve IE and is associated with more perivalvular complications and neurological events. The differences in survival with TAV-IE are probably related to the age and comorbidity differences between these two populations.
二叶式主动脉瓣（BAV）是最常见的先天性心脏病，感染性心内膜炎（IE）风险增加。关于孤立性原发性BAV-IE的数据很少。本研究的目的是比较三尖瓣主动脉瓣（TAV）IE和BAV-IE患者在特征、治疗和预后方面的情况。
我们纳入了法国亚眠和马赛医院以及意大利萨勒诺医院3个中心连续收治的728例孤立性原发性主动脉瓣IE患者。我们研究了年龄、性别和合并症指数匹配前后的住院死亡率和长期死亡率。中位随访时间为67.2 [四分位间距：19 - 120]个月。
在728例患者中，123例（16.9%）患有BAV。与TAV-IE患者相比，BAV-IE患者更年轻，合并症更少，且男性居多。他们出现更多的严重神经系统事件和瓣周并发症（均P < 0.05）。52%的BAV-IE病例进行了早期手术（<30天），而TAV-IE为42.8%（P = 0.061）。BAV-IE患者的10年生存率为74±5%，而TAV-IE患者为66±2%（P = 0.047）。在倾向评分匹配（年龄、性别和合并症）后，两组死亡率无差异，估计10年生存率分别为73±5%和76±4%（P = 0.91）。
BAV在孤立性主动脉瓣IE患者中很常见，且与更多的瓣周并发症和神经系统事件相关。与TAV-IE患者生存率的差异可能与这两组人群的年龄和合并症差异有关。
