Characteristics and Prognosis of Patients With Left-Sided Native Bivalvular Infective Endocarditis

Yohann Bohbot (1) , Fanny Peugnet (2) , Audrey Lieu (3) , Andreina Carbone (4) , Basile Mouhat (5) , Mary Philip (6) , Frederique Gouriet (7, 8) , Florent Arregle (6) , Florent Chevalier (9) , Momar Diouf (2) , Dan Rusinaru (2, 1) , Gilbert Habib (10) , Christophe Tribouilloy (3, 1)

1 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
2 CHU Amiens-Picardie
3 UPJV - Université de Picardie Jules Verne
4 Département de Cardiologie [Hôpital de la Timone - APHM]
5 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
6 AMU SMPM MED - Aix-Marseille Université - École de médecine
7 MEPHI - Microbes évolution phylogénie et infections
8 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
9 Centre hospitalier de Saint-Quentin
10 TIMONE - Hôpital de la Timone [CHU - APHM]

Background: Most cases of left-sided native valve infective endocarditis (IE) involve a single valve and little is known concerning IE that simultaneously affects the aortic and mitral valves. Methods: We aimed to determine the characteristics, identify the prognostic factors, and define the effect of early surgery for patients with left-sided native bivalvular IE. This analysis included 1340 consecutive patients who presented with definite acute left-sided native valve IE in a 2-centre cohort study. Results: A bivalvular involvement was present in 257 patients (19%). Patients with bivalvular IE had more embolic events (P = 0.044), congestive heart failure (P = 0.016), vegetations, and perivalvular complications (both P < 0.001) than those with monovalvular IE. Early surgery was more frequent for patients with bivalvular IE (P < 0.001). Thirty-day mortality was higher for patients with bivalvular IE than for those with monovalvular IE (24.5% vs 17.6%; P = 0.008), even after adjustment (odds ratio, 1.86 [95% confidence interval, 1.26-2.73]; P < 0.001). Estimated 10-year survival was 70% +/- 1% for monovalvular IE and 59% +/- 3% for bivalvular IE (P = 0.002). Bivalvular IE was still associated with mortality in multivariable Cox analysis, after adjustment for covariates including age, neurological events, congestive heart failure, Staphylococcus spp infection, perivalvular complications, and early surgery (hazard ratio, 1.70 [95% confidence interval, 1.31-2.11]; P < 0.001). Early surgery was associated with increased survival for patients with bivalvular IE (79% +/- 4% vs 35% +/- 6%; P < 0.001). Conclusions: Bivalvular involvement is frequent in left-sided native valve IE, is associated with more embolic events and congestive heart failure than monovalvular IE, and patients are at a high risk of death. Early surgery is associated with improved survival and should be systematically discussed in the absence of contraindication.

Domaines: Sciences du Vivant [q-bio]

Yohann Bohbot, Fanny Peugnet, Audrey Lieu, Andreina Carbone, Basile Mouhat, et al.. Characteristics and Prognosis of Patients With Left-Sided Native Bivalvular Infective Endocarditis. Canadian Journal of Cardiology, 2021, 37 (2), pp.292-299. ⟨10.1016/j.cjca.2020.03.046⟩. ⟨hal-03579646⟩