title: Periannular complications in infective endocarditis involving native aortic valves.
abstract: The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p <0.001), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 172 patients (86%), and in-hospital mortality in the overall population was 29%. Multivariate analysis identified age >60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality.
authors.affiliation: Corporacio Sanitaria Parc Tauli-Hospital de Sabadell, Sabadell, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Anguera
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Jose Alberto
authors.initials: JA
authors.lastname: San Roman
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Tomas
authors.initials: T
authors.lastname: Ripoll
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Enrique
authors.initials: E
authors.lastname: Navas
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez-Juanatey
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garcia-Bolao
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Aristides
authors.initials: A
authors.lastname: de Alarcon
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarria
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rufi
authors.forename: Francisco
authors.initials: F
authors.lastname: Miralles
authors.forename: Carles
authors.initials: C
authors.lastname: Pare
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Elisa
authors.initials: E
authors.lastname: de Lazzari
authors.forename: Joan R
authors.initials: JR
authors.lastname: Guma
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000382:microbiology* / Q000601:surgery; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016157:Vascular Fistula / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy
chemical_list: D000890:Anti-Infective Agents