title: Infective endocarditis in patients with bicuspid aortic valve: Clinical characteristics, complications, and prognosis.
abstract: BACKGROUND
  Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE).
  
  
  METHODS
  Retrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV).
  
  
  RESULTS
  Of a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38-26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048).
  
  
  CONCLUSIONS
  Patients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher.
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España. Electronic address: vmbecerram@gmail.com.
authors: Víctor M
authors: VM
authors: Becerra-Muñoz
authors: UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors: Josefa
authors: J
authors: Ruíz-Morales
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Isabel
authors: I
authors: Rodríguez-Bailón
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Gemma
authors: G
authors: Sánchez-Espín
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Miguel A
authors: MA
authors: López-Garrido
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Juan
authors: J
authors: Robledo-Carmona
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Ana
authors: A
authors: Guijarro-Contreras
authors: UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors: María Victoria
authors: MV
authors: García-López
authors: Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors: Rada
authors: R
authors: Ivanova-Georgieva
authors: UGC de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors: Laura
authors: L
authors: Mora-Navas
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Juan José
authors: JJ
authors: Gómez-Doblas
authors: UGC Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Red de Investigación Cardiovascular (RIC), Málaga, España.
authors: Eduardo
authors: E
authors: de Teresa-Galván
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D000082882:Bicuspid Aortic Valve Disease; D001927:Brain Diseases / Q000453:epidemiology; D003131:Combined Modality Therapy; D015897:Comorbidity; D004198:Disease Susceptibility; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bicuspid aortic valve; Complicaciones perivalvulares; Endocarditis infecciosa; Infectious endocarditis; Peri-valvular complications; Válvula aórtica bicúspide