Clinical characteristics and outcome of infective endocarditis in adults with bicuspid aortic valves: a multicentre observational study.
OBJECTIVE
To analyse characteristics and outcomes of infective endocarditis (IE) on bicuspid aortic valves (BAV) and to compare the risk of death according to the presence or absence of BAV.


METHODS
5-year observational study.


METHODS
Population of 856 patients with definite IE according to the Duke criteria from two tertiary centres (Amiens and Marseille, France).


METHODS
310 consecutive patients with definite native aortic valve IE enrolled between 1991 and 2007.


METHODS
Patients underwent transthoracic and transoesophageal echocardiography during hospitalisation. Surgery was performed on a case-by-case basis according to conventional guidelines.


METHODS
In-hospital mortality and 5-year overall mortality.


RESULTS
Patients with BAV IE (n=50, 16%) were younger, had fewer comorbidities and a higher frequency of aortic perivalvular abscess (50%). Presence of BAV (OR 3.79 (1.97-7.28); p<0.001) was independently predictive of abscess formation. Early surgery was performed in 36 BAV patients (72%) with a peri-operative mortality of 8.3%, comparable to that of patients with tricuspid aortic valve IE (p=0.89). BAV was not independently predictive of in-hospital mortality (OR 0.89 (0.28-2.85); p=0.84) or 5-year survival (HR 0.71 (0.37-1.36); p=0.30). Age, comorbidities, heart failure, Staphylococcus aureus and uncontrolled infection were associated with increased 5-year mortality in BAV patients.


CONCLUSIONS
BAV is frequent in adults with native aortic valve IE. Patients with BAV IE incur high risk of abscess formation and require early surgery in almost three-quarters of cases. IE is a severe complication in the setting of BAV and warrants prompt diagnosis and treatment.
Tribouilloy
C
C
Department of Cardiology, INSERM, ERI-12, Amiens, France. tribouilloy.christophe@chu-amiens.fr
Rusinaru
D
D
Sorel
C
C
Thuny
F
F
Casalta
J-P
JP
Riberi
A
A
Jeu
A
A
Gouriet
F
F
Collart
F
F
Caus
T
T
Raoult
D
D
Habib
G
G
D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis