Can prosthesis type influence the recurrence of infective endocarditis after surgery for native valve endocarditis? A propensity weighted comparison

被引:5
作者
Rubino, Antonino S. [1 ,2 ]
Della Ratta, Ester E. [1 ]
Galbiati, Denise [1 ]
Ashurov, Rasul [1 ]
Galgano, Viviana L. [1 ]
Montella, Antonio P. [1 ]
De Feo, Marisa [1 ]
Della Corte, Alessandro [1 ]
机构
[1] Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, Div Cardiac Surg, Via Leonardo Bianchi, I-80131 Naples, Italy
[2] Papardo Hosp, Cardiothoracovasc Dept, Cardiac Surg Unit, Messina, Italy
关键词
Endocarditis; Recurrence; Reoperation; Prosthesis; Survival; REPLACEMENT;
D O I
10.1093/ejcts/ezab238
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: Our goal was to investigate whether the incidence of valve-related adverse events might be different depending on the valve substitute after valve replacement for left-sided native valve endocarditis. METHODS: We assessed the long-term freedom from recurrence, reoperation and survival of 395 patients who had valve replacements for native valve endocarditis (314 mechanical vs 81 biological). Age <18 years, reoperation, prosthetic endocarditis, right valve involvement, valve repair and homograft implants were the main exclusion criteria. The balance between the 2 groups was addressed by weighting the results on the inverse of the propensity score. RESULTS: After inverse probability of treatment weighting (IPTW), freedom from recurrence of infective endocarditis was not significantly different (mechanical 84.1 +/- 3.2% vs 50.6 +/- 21.7%; P = 0.29) nor was freedom from reoperation different (mechanical 85.7 +/- 3.1% vs biological 50.9 +/- 21.9%; P = 0.29). Excluding competing deaths, patients receiving a bioprosthesis had a similar subdistribution hazard of the above end points compared to recipients of a mechanical valve [recurrence IPTW: hazard ratio (HR) 1.631, 95% confidence interval (CI) 0.756-3.516; P = 0.21; reoperation IPTW-HR 1.737, 95% CI 0.780-3.870; P = 0.18]. Mechanical valves were associated with improved long-term survival (34.9 +/- 5.8% vs 10.5 +/- 7.4% at 30 years; P = 0.0009; in particular: aortic valve subgroup 41.6 +/- 9.3% vs 10.1 +/- 8.2%; P < 0.0001), although the hazard of cardiovascular mortality did not favour either valve type (IPTW: HR 1.361, 95% CI 0.771-2.404; P = 0.29). CONCLUSIONS: Our analysis showed a clinical trend in favour of mechanical valves as valve substitutes for native valve endocarditis, especially in the aortic position. In view of long-term freedom from adverse events, the choice of the valve type should be tailored according to patient characteristics and specific clinical conditions.
引用
收藏
页码:1388 / 1394
页数:7
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