Stentless vs. stented bioprosthesis for aortic valve replacement: A case matched comparison of long-term follow-up and subgroup analysis of patients with native valve endocarditis (original) (raw)
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JAMA Internal Medicine, 2013
IMPORTANCE There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right-or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum.
Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement
Circulation
CORRESPONDENCE P rosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis and accounts for 20% of all cases of infective endocarditis. 1,2 However, studies reporting the incidence of PVE after surgical aortic valve replacement (AVR) are scarce and based mainly on noncontemporary patient cohorts. Whether PVE affects biological and mechanical aortic valves to the same extent remains unknown. Therefore, we investigated the incidence and risk of PVE after surgical AVR in patients with biological and mechanical valves. This observational, nationwide, population-based cohort study was approved by the regional Human Research Ethics Committee in Stockholm, Sweden (Dnr. 2016/1241-32) and is registered at ClinicalTrials.gov (Unique identifier: NCT02276950). No informed consent from patients was required. The SWEDE-HEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register was used to obtain the study population. The unique personal identity number was used for cross-linking patient-level data from other national healthcare registers as described previously. 3 All patients who underwent AVR with a biological or mechanical valve prosthesis in Sweden from January 1, 1995, to December 31, 2012, were included in the study. Patients with multiple valve surgeries were excluded. Person-time in days was counted from the date of surgery until the date of diagnosis of PVE, death, or end of follow-up (December 31, 2012, for PVE and March 24, 2014, for death). Cox regression was used to estimate the relative risk of PVE. Data management and statistical analyses were performed with Stata version 14.2 (StataCorp LP, College Station, TX). We included 26 580 patients; 16 426 (62%) received a bioprosthesis and 10 154 (38%) received a mechanical valve. Patients with bioprostheses were older (mean age, 74.1 versus 61.0 years) and had more comorbidities than patients with mechanical valves. During a mean follow-up of 6.2 years (maximum, 18.0 years), 940 patients (3.5%) were hospitalized for infective endocarditis. The event rates and crude and adjusted risks for PVE are shown in the Table. The incidence rate of PVE was 0.57% (95% confidence interval [CI], 0.54-0.61) per person-year. The incidence rates of PVE in biological and mechanical valves at 0 to 1, 1 to 5, 5 to 10, and 10 to 15 years' follow-up are shown in the Table. The risk of PVE was higher in patients with bioprostheses, both in the unadjusted analysis (hazard ratio [HR], 1.51; 95% CI, 1.31-1.74) and in the multivariable-adjusted analysis (HR, 1.54; 95% CI, 1.29-1.83). The results were consistent in age-stratified and agematched analyses. The adjusted risk of both early (within 1 year) endocarditis (HR, 1.65; 95% CI, 1.16-2.37) and late endocarditis (HR, 1.53; 95% CI, 1.25-1.86) was higher in patients with bioprostheses. In this nationwide, population-based cohort study, the incidence of PVE after AVR was 0.57% per person-year. The risk of PVE was highest during the first year after AVR; thereafter, the yearly rate of PVE was halved and remained stable during
EuroIntervention
Aims: The aim of this study was to compare the risk of prosthetic valve endocarditis (PVE) in patients with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Methods and results: The FinnValve registry included data from 6,463 consecutive patients who underwent TAVR (n=2,130) or SAVR (n=4,333) with a bioprosthesis from 2008 to 2017. PVE was defined according to the modified Duke criteria. In this study, the incidence of PVE was 3.4/1,000 person-years after TAVR, and 2.9/1,000 person-years after SAVR. In competing risk analysis there was no significant difference in the risk of PVE between patients with TAVR and SAVR over an eight-year observational period. Male gender (HR 1.73, 95% CI: 1.04-2.89) and deep sternal wound infection or vascular access-site infection (HR 5.45, 95% CI: 2.24-13.2) were positively associated with PVE, but not type of procedure (HR 1.09, 95% CI: 0.59-2.01) in multivariate analysis. The mortality rate was 37.7% at one month and increased to 52.5% at one year. Surgical treatment was independently associated with decreased in-hospital mortality (HR 0.34, 95% CI: 0.21-0.61).