title: One-year outcome following biological or mechanical valve replacement for infective endocarditis.
abstract: BACKGROUND
  Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality.
  
  
  RESULTS
  Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298).
  
  
  CONCLUSIONS
  Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.
authors.affiliation: Hopital Louis Pradel, Lyon-Bron, France. Electronic address: francois.delahaye@chu-lyon.fr.
authors.forename: F
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: V H
authors.initials: VH
authors.lastname: Chu
authors.affiliation: Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Altclas
authors.affiliation: University Hospital for Infectious Diseases, Zagreb, Croatia.
authors.forename: B
authors.initials: B
authors.lastname: Barsic
authors.affiliation: Hopital Louis Pradel, Lyon-Bron, France.
authors.forename: A
authors.initials: A
authors.lastname: Delahaye
authors.affiliation: Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Freiberger
authors.affiliation: Flinders Medical Centre, Adelaide, Australia.
authors.forename: D L
authors.initials: DL
authors.lastname: Gordon
authors.affiliation: Mater Hospitals, Dublin, Ireland.
authors.forename: M M
authors.initials: MM
authors.lastname: Hannan
authors.affiliation: University Medical Center, Pointe-à-Pitre, France.
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.affiliation: American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: S S
authors.initials: SS
authors.lastname: Kanj
authors.affiliation: Medical Center, Ljubljana, Slovenia.
authors.forename: T
authors.initials: T
authors.lastname: Lejko-Zupanc
authors.affiliation: Hospital Clinic - IDIBAPS, Barcelona, Spain.
authors.forename: C A
authors.initials: CA
authors.lastname: Mestres
authors.affiliation: Khon Kaen University, Khon Kaen, Thailand.
authors.forename: O
authors.initials: O
authors.lastname: Pachirat
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: P
authors.initials: P
authors.lastname: Pappas
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janerio, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Lamas
authors.affiliation: CHU Nancy-Brabois, Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Selton-Suty
authors.affiliation: Canberra Hospital, Woden, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Tan
authors.affiliation: Pontchaillou University Hospital, Rennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Wang
mesh_terms: D000368:Aged; D001705:Bioprosthesis / Q000382:microbiology* / Q000639:trends; D015331:Cohort Studies; D004696:Endocarditis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality*; D016896:Treatment Outcome
keywords: Infective endocarditis; Surgery; Valve prosthesis