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Native aortic versus mitral valve infective endocarditis: A nationwide registry study

Journal article
Authors Abel Van Vlasselaer
Magnus Rasmussen
Lars Olaison
Johan Nilsson
Sigurdur Ragnarsson
Published in Open Heart
Volume 6
Issue 1
Publication year 2019
Published at Institute of Biomedicine, Department of Infectious Medicine
Language en
Links https://doi.org/10.1136/openhrt-201...
Keywords endocarditis, left-sided native valve infective endocarditis, microbiology, outcome, surgery
Subject categories Thoracic surgery, Infectious Medicine

Abstract

© Author(s) (or their employer(s)) 2019. Background Native aortic and mitral valve infective endocarditis (AVE and MVE, respectively) are usually grouped together as left-sided native valve infective endocarditis (LNVE), while the differences between AVE and MVE have not yet been properly investigated. We aimed to compare AVE and MVE in regard to patient characteristics, microbiology and determinants of survival. Methods We conducted a retrospective study using the Swedish national registry on infective endocarditis, which contains nationwide patient data. The study period was 2007-2017, and included cases were patients who had either AVE or MVE. Results We included 649 AVE and 744 MVE episodes. Staphylococcus aureus was more often the causative pathogen in MVE (41% vs 31%, p<0.001), whereas enterococci were more often the causative pathogen in AVE (14% vs 7.4%, p<0.001). Perivalvular involvement occurred more frequently in AVE (8.5% vs 3.5%, p<0.001) and brain emboli more frequently in MVE (21% vs 13%, p<0.001). Surgery for IE was performed more often (35% vs 27%, p<0.001) and sooner after diagnosis (6.5 days vs 9 days, p=0.012) in AVE than in MVE. Several risk predictors differed between the two groups. Conclusions The microbiology seems to differ between AVE and MVE. The causative pathogen was not associated with mortality in AVE. The between-group differences regarding clinical presentation and predictors of survival indicate that it may be important to differentiate AVE from MVE in the treatment of LNVE.

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