Gender-Based Long-Term Surgical Outcome in Patients with Active Infective Aortic Valve Endocarditis

Abstract

BackgroundThe aim of this observational, single-center study was to evaluate the impact of gender on surgical outcome in patients with active infective endocarditis (AIE) of the aortic valve.Material/MethodsBetween October 1994 and January 2011, 755 patients (558 men and 297 women) underwent surgery for AIE at the Leipzig Heart Center, Germany, according to the modified Duke criteria. Data were collected before surgery and as the study was ongoing. Gender influence on survival was evaluated (Kaplan-Meier curves). Cox proportional models were used to evaluate gender differences in relation to early mortality (within 30 days) and late mortality (up to 10 years).ResultsThe early mortality rate was 15.0% among men and 23.0% among women, which was statistically significant different (p=0.01). In male patients, variables associated with overall mortality were age (HR 1.63, 95% CI 1.43–1.86; p<0.001), insulin-dependent diabetes mellitus (HR 2.02, 95% CI 1.48–2.75; p<0.001), preoperative low ejection fraction (OR 0.99, 95% CI 0.98–0.99; p=0.002), previous cardiac surgery (OR 1.62, 95% CI 1.22–2.13; p=0.001), preoperative ventilation (OR 1.77, 95% CI 1.14–2.75; p=0.012), preoperative dialysis (OR 1.89, 95% CI 1.20–2.98; p=0.006), NYHA Class IV (OR 1.56, 95% CI 1.12–2.15; p=0.008), and involvement of multiple valves (OR 1.65, 95% CI 1.24–2.19; p=0.001) had a statistically significant influence on the late mortality. Focus identification (OR 1.75, 95% CI 1.08–2.77; p=0.023), involvement of multiple valves (OR 1.52, 95% CI 1.02–2.26; p=0.040), preoperative dialysis (OR 3.65, 95% CI 1.96–6.77; p<0.001), and age (OR 1.53, 95% CI 1.28–1.82; p<0.004) were predictive risk factors for late mortality in women with AIE (OR 3.6, 95% CI 1.5–8.4; p<0.004).ConclusionsThis study demonstrated distinct gender-based differences in risk of mortality in patients with AIE (who were undergoing surgical treatment) with different early and long-term outcomes.

Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre

“…The three-year mortality rate of IE in the literature often exceeds 30% [ 2 ]. The overall mortality rate at three years in our series was 29%.…”

“…Estrogens may play a protective role against endothelial damage. Moreover, females tend to encounter heart disease at an older age and have a higher incidence of comorbid conditions, which may result in a worse outcome [ 2 , 3 ]. Deepening the analysis, we found that the female gender was not an independent predictor of adverse prognosis, as opposed to age and EUROSCORE II, that confirmed to be independent predictors at multivariate analysis.…”

“…Despite recent diagnostic and therapeutic advances, the mortality of IE remains high in most series, with in-hospital mortality even of 24% [ 1 ], and three-year mortality over 30% [ 2 ]. The literature reports some prognostic factors associated with higher mortality, such as advanced age, female gender [ 1 – 3 ], prosthetic valve endocarditis [ 4 ], Staphylococcus aureus aetiology [ 5 ], comorbidity [ 6 – 12 ], leucocytosis, hypoalbuminemia, C-reactive protein levels, elevated ERS [ 13 ], and IE complications [ 6 ].…”

Gender differences in clinical features and complications of infective endocarditis: 11-year experience of a single institute in Egypt

“…Gender differences and their impact on the clinical profile and outcome in cardiovascular diseases are a debatable issue in the literature [1][2][3]. These differences may be attributed to a variety of factors including variable comorbidities, treatment biases, or inherent physiologic differences [3].…”

“…These differences may be attributed to a variety of factors including variable comorbidities, treatment biases, or inherent physiologic differences [3]. Previous reports addressing this issue in patients with infective endocarditis (IE) did not examine its relationship with outcomes and treatment decisions systematically [2,3]. IE occurs in males more frequently than females, with 2:1 to 9:1 ratio [4][5][6].…”