Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 27;13(1):153.
doi: 10.3390/jcm13010153.

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry

Antonio Salsano  1   2 , Michele Di Mauro  3 , Laura Labate  4   5 , Alessandro Della Corte  6 , Federica Lo Presti  6 , Michele De Bonis  7 , Cinzia Trumello  7 , Mauro Rinaldi  8 , Erik Cura Stura  8 , Guglielmo Actis Dato  9 , Giuseppe Punta  9 , Francesco Nicolini  10 , Davide Carino  10 , Carlo De Vincentiis  11 , Andrea Garatti  11 , Giangiuseppe Cappabianca  12 , Andrea Musazzi  12 , Diego Cugola  13 , Maurizio Merlo  13 , Davide Pacini  14 , Gianluca Folesani  14 , Sandro Sponga  15 , Igor Vendramin  15 , Alberto Pilozzi Casado  16 , Francesco Rosato  16 , Elisa Mikus  17 , Carlo Savini  17 , Francesco Onorati  18 , Giovanni Battista Luciani  18 , Roberto Scrofani  19 , Francesco Epifani  19 , Francesco Musumeci  20 , Antonio Lio  20 , Andrea Colli  21 , Giosuè Falcetta  21 , Salvatore Nicolardi  22 , Salvatore Zaccaria  22 , Enrico Vizzardi  23 , Antonio Pantaleo  24 , Giuseppe Minniti  24 , Emmanuel Villa  25 , Margherita Dalla Tomba  25 , Francesco Pollari  26 , Fabio Barili  16 , Alessandro Parolari  27   28 , Roberto Lorusso  29 , Francesco Santini  1   2 ; Italian Group of Research for Outcome in Cardiac Surgery (GIROC)
Affiliations

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry

Antonio Salsano et al. J Clin Med. .

Abstract

Background: Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years.

Methods: This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test.

Results: Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039).

Conclusions: The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.

Keywords: aortic valve replacement; endocarditis; prosthetic heart valve.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Covariate balance plot for adjusted and unadjusted samples.
Figure A2
Figure A2
Love plot graphically displaying covariate balance before and after adjusting.
Figure A3
Figure A3
ROC curve of the propensity scores.
Figure 1
Figure 1
Trend in proportion of the implanted mechanical versus biological prostheses in the overall cohort (A), in age class 40–49 years (B), and in age class 50–65 years (C). Green line: annual fluctuations in percentages; red line: linear trend; gray area: confidence interval around linear trend.
Figure 2
Figure 2
Approximately 15-year survival after AVR for IE in patients aged 40 to 65 years according to prosthetic type: mechanical prostheses (green line) or bioprostheses (red line). Adjusted survival in patients matched by propensity score has been reported as hazard ratio (HR) and 95% confidence interval (CI).
Figure 3
Figure 3
Cumulative incidence of recurrent endocarditis after AVR in IE patients aged 40 to 65 years according to prosthetic type: mechanical prostheses (green line) vs. bioprostheses (red line). Adjusted estimates in patients matched by propensity score have been reported as hazard ratio (HR) and 95% confidence interval (CI).
See this image and copyright information in PMC

References

    1. Citro R., Chan K.-L., Miglioranza M.H., Laroche C., Benvenga R.M., Furnaz S., Magne J., Olmos C., Paelinck B.P., Pasquet A., et al. Clinical profile and outcome of recurrent infective endocarditis. Heart. 2022;108:1729–1736. doi: 10.1136/heartjnl-2021-320652. - DOI - PubMed
    1. Delgado V., Marsan N.A., de Waha S., Bonaros N., Brida M., Burri H., Caselli S., Doenst T., Ederhy S., Erba P.A., et al. 2023 ESC Guidelines for the management of endocarditis. Eur. Heart J. 2023;44:3948–4042. doi: 10.1093/eurheartj/ehad193. - DOI - PubMed
    1. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J., Capodanno D., Conradi L., De Bonis M., De Paulis R., et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2022;43:561–632. doi: 10.1093/eurheartj/ehab395. - DOI - PubMed
    1. Kytö V., Ahtela E., Sipilä J., Rautava P., Gunn J. Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis. Interact. Cardiovasc. Thorac. Surg. 2019;29:386–392. doi: 10.1093/icvts/ivz122. - DOI - PubMed
    1. Delahaye F., Chu V.H., Altclas J., Barsic B., Delahaye A., Freiberger T., Gordon D.L., Hannan M.M., Hoen B., Kanj S.S., et al. One-year outcome following biological or mechanical valve replacement for infective endocarditis. Int. J. Cardiol. 2015;78:117–123. doi: 10.1016/j.ijcard.2014.10.125. - DOI - PubMed