P2762Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery

Abstract

Abstract Introduction Infective endocarditis (IE) may require heart valve surgery. However, it is well-known that heart valve surgery itself and previous IE predispose to IE. Purpose To access the risk of recurrent IE compared with first-time IE following heart valve surgery. Methods Using Danish nationwide registries, patients undergoing left-sided heart valve surgery (i.e. valve replacement or repair) in the course of a first-time IE hospitalization (1996–2017) were identified and matched with patients undergoing left-sided heart valve surgery due to another cause than IE in a 1:1 ratio. Patients were stratified according to type of surgical valve intervention and affected valve. The comparative risk of IE was assessed by cumulative incidence curves and multivariable Cox regression analyses. Results The study population comprised 975 patients with a first-time admission for left-sided IE requiring heart valve surgery (median age, 64.3 years [interquartile range 55.7–72.1], 77.6% men) matched with 975 controls undergoing left-sided heart valve surgery due to other causes than IE. The risk of recurrent IE was significantly higher than the risk of first-time IE following heart valve surgery (5.5% and 3.1% by 10 years, hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.07–2.78) (Figure 1). The risk of IE recurrence was not significantly different in patients with IE undergoing valve replacement versus valve repair (5.6% and 5.4% respectively, HR 1.76, 95% CI 0.79–3.05). Likewise, the risk of IE recurrence was not significantly different for mitral versus aortic valve patients (3.5% and 6.3%, respectively, HR 0.73, 95% CI 0.36–1.48). Yet, the risk of IE recurrence was significantly higher among IE patients with biological versus mechanical prostheses (6.4% and 4.6%, respectively, HR 2.20, 95% CI 1.13–4.31). Figure 1: Cumulative incidences Conclusion Following left-sided heart valve surgery, the associated risk of recurrent IE was significantly higher than the risk of first-time IE. Acknowledgement/Funding None