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

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Abstract

Objective

Infective endocarditis (IE) may require heart valve surgery. It is well known that heart valve surgery itself and previous IE predispose to IE. However, data are sparse on whether the risk of IE is different among patients undergoing valve surgery due to IE and other causes (i.e. recurrent vs. first-time IE).

Methods

Using Danish nationwide registries, patients undergoing left-sided heart valve surgery in the course of an IE hospitalization (1996–2017) were identified and matched with controls 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 recurrent vs. first-time IE was assessed by cumulative incidence curves and multivariable Cox regression analyses.

Results

The study population comprised 971 patients with a first-time admission for IE requiring heart valve surgery matched with 971 controls undergoing 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 3.0% by 10 years, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.02–2.70). The risk of IE recurrence was not significantly different comparing valve replacement and valve repair (5.5% and 5.3%, respectively, HR 1.60, 95% CI 0.71–3.60). Yet, the risk of IE recurrence was significantly higher among patients with biological versus mechanical prostheses (6.3% and 4.6%, respectively, HR 2.00, 95% CI 1.02–3.70).

Conclusions

Following heart valve surgery, the risk of recurrent IE was significantly higher than the risk of first-time IE.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Eva Havers-Borgersen, Jawad H. Butt, Lauge Østergaard, Henning Bundgaard, Lars Køber & Emil L. Fosbøl

  2. Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Morten Smerup

  3. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark

    Niels Eske Bruun

  4. Clinical Institute, Copenhagen University, Copenhagen, Denmark

    Niels Eske Bruun

  5. Clinical Institute, Aalborg University, Aalborg, Denmark

    Niels Eske Bruun

  6. Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark

    Gunnar H. Gislason

  7. Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark

    Christian Torp-Pedersen

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  1. Eva Havers-Borgersen
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  2. Jawad H. Butt
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Correspondence to Eva Havers-Borgersen.

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Conflict of interest

GHG: Research Grants from Bayer, Bristol-Myers Squibb, Pfizer, AstraZeneca and Boehring Ingelheim. CTP: consultant fees and research funding from Bayer and Biotronic. ELF: previous research funding from Janssen and Janssen and Bristol-Myers. EHB, JHB, LØ, HB, MS and LK: none declared.

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Havers-Borgersen, E., Butt, J.H., Østergaard, L. et al. Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery. Clin Res Cardiol 109, 1342–1351 (2020). https://doi.org/10.1007/s00392-020-01628-7

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  • DOI: https://doi.org/10.1007/s00392-020-01628-7

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