Valvular perforation in left-sided native valve infective endocarditis

Abstract

Background: Left-sided native valve infective endocarditis (LNVIE) can result in mitral (MP) and aortic (AP) valve perforation, the prognostic significance of which remains poorly defined. Hypothesis: Valvular perforation is associatedwith worse outcomes. Methods: Retrospective review of patients with LNVIE during 1998-2005 was performed to examine characteristics and outcome predictors of LNVIE complicated by valve perforation. Patientswere stratified as: group A: MP or AP detected by transesophageal echocardiography (TEE) or surgery; group B: no TEE evidence of MP or AP. Results: A total of 123 patients were included (group A = 47, group B = 76). In group A, 35 patients (74.5%) hadMP alone, 11 (23.4%) had AP alone, and 1 patient had both. Severe valvular insufficiencywas encountered more in group A (85.1% versus 59.2%, p = 0.003), so was hemodialysis (40.4% versus 17.1%, p = 0.004) and indications for valvular surgery (93.6%versus 77.6%, p = 0.02).Group A had a higher rate of in-hospitaldeath (31.9% versus 15.8%, p = 0.04). Among patients who had an indication for valvular surgery, the in-hospital mortality rate for those who underwent valvular surgery was 16.7% in group A, and 7.9%in group B (p = 0.4), compared to thosewho did not undergo surgery (71.4%versus 33.3%, p = 0.04). Amongst survivors, hospital stay was on average 9.2 d longer in group A (38.9 versus 29.7 d, p = 0.05). Univariate analysis revealed association between lower survival and valvular perforation (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.17-0.95), that was lost after adjusting for hemodialysis. Conclusions: Valve perforation complicating LNVIE is associated with hemodialysis, severe valvular insufficiency, and significant morbidity and mortality. Compared to conservativemanagement, early surgical intervention is associatedwith improved survival. © 2009Wiley Periodicals, Inc.