Incidence of Infective Endocarditis in Patients With Bicuspid Aortic Valves in the Community

Michelena, Héctor I.; Katan, Ognjen; Suri, Rakesh M.; Baddour, Larry M.; Enríquez-Sarano, Maurice

doi:10.1016/j.mayocp.2015.10.011

Cited by 52 publications

(41 citation statements)

References 8 publications

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“…In three previous cohorts, the incidence of native valve IE in BAV has been reported to be 2%–2.5% 6–8. A recent community-based report showed native BAV IE i ncidence of 9.9 per 10 000 patient-years 30. Two recent studies which followed patients up to 2015 showed a higher incidence of 3.7%–5% 12 13.…”

Section: Resultsmentioning

confidence: 96%

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Masri

Svensson

Griffin

et al. 2017

Heart

162

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We performed a systematic review of the current state of the literature regarding the natural history and outcomes of bicuspid aortic valve (BAV). PubMed and the reference lists of the included articles were searched for relevant studies reporting on longitudinal follow-up of BAV cohorts (mean follow-up ≥2 years). Studies limited to patients undergoing surgical interventions were excluded. 13 studies (11 502 patients with 2-16 years of follow-up) met the inclusion criteria. There was a bimodal age distribution (30-40 vs ≥50 years), with a 3:1 male to female ratio. Complications included moderate to severe aortic regurgitation (prevalence 13%-30%), moderate to severe aortic stenosis (12%-37%), infective endocarditis (2%-5%) and aortic dilatation (20%-40%). Aortic dissection or rupture was rare, occurring in 38 patients (0.4%, 27/6446 in native BAV and 11/2232 in post). With current aggressive surveillance and prophylactic surgical interventions, survival in three out of four studies was similar to that of a matched general population. In this systematic review, valvular dysfunction warranting surgical intervention in patients with BAV were common, aortic dissection was rare and, with the current management approach, survival was similar to that of the general population.

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Section: Resultsmentioning

confidence: 96%

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Masri

Svensson

Griffin

et al. 2017

Heart

162

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“…Over 25% of BAV patients also develop ascending aorta aneurysms (AA) 25 years after BAV diagnosis, with cohort risks of aortic dissection ranging from 0.5% to 1% . In addition, infective endocarditis (IE) is observed in ~2% of contemporary BAV cohorts …”

Section: Introductionmentioning

confidence: 99%

“…In addition to allowing population‐based analysis of BAV cohorts, Mayo Clinic (Rochester) serves as a tertiary center with high cardiac diagnostic and surgical referral volumes, allowing survival analysis of large BAV patient cohorts at different stages of their condition. In order to examine sex‐specific morbidity patterns in BAV patients, we analyzed the largest population‐based community cohort with the longest reported follow‐up . To verify those morbidity patterns and test the hypothesis that survival may be compromised in BAV adults across evolving echocardiographic‐clinical junctures, we analyzed overall and sex‐specific survival in a tertiary clinical referral cohort and in an AVR referral cohort.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

Michelena

Suri²,

Katan

et al. 2016

JAHA

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BackgroundSex‐related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic‐clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic‐clinical stages remains undetermined.Methods and ResultsAnalysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow‐up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow‐up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow‐up 6±5 years). For the community cohort, 20‐year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV‐related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25‐year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05‐1.29) for men versus 1.67 (95% CI 1.38‐2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.34 (95% CI 1.22‐1.47) for men versus 1.63 (95% CI 1.40‐1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04).ConclusionsWithin evolving echocardiographic‐clinical stages, the long‐term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV‐related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.

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“…We therefore accounted for the unknown frequency of BAV in the source population using the frequency of non-aortic valve IE in both groups, making the assumption that the incidence of IE of non-aortic valves would be the same between patients with BAV and TAV. It is likely we observed a higher risk than recently reported25 by accounting for undiagnosed BAV in the community, by normalising the incidence of aortic valve IE and assuming equivalent risk of IE of other valves.…”

Section: Discussionmentioning

confidence: 63%

Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

et al. 2017

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ObjectivePatients with structural abnormalities of cardiac valves, including bicuspid aortic valve (BAV), are said to be at higher risk of infective endocarditis (IE). We sought to determine the risk of IE of the BAV compared with the tricuspid aortic valve (TAV) and to determine the risk of aortic valve replacement and mortality after IE.MethodsFrom medical records of two US and one Italian hospitals, patients with their first episode of IE of any native valve were identified. In the US cohort 42 patients with BAV and 393 patients with TAV with IE occurring between 1 January 2000 and 30 June 2014 were identified. In the Italian cohort 48 patients with BAV and 341 patients with TAV with IE underwent valve replacement surgery between 1 January 2000 and1 November 2015. The risk of IE for BAV and TAV and subsequent outcomes were determined after matching to patients without IE.ResultsAfter adjustment for risk factors, the risk of IE in the US cohort was 23.1 (95% CI 8.1 to 100, p <0.0001) times greater for BAV than TAV. Patients with BAV with IE were more likely to have an aortic root abscess. Within the subsequent 5 years, BAV patients with IE were more likely to undergo valve replacement (85%) than TAV patients with IE (46%). Patients with IE were at increased risk of death. The findings were similar in the Italian cohort.ConclusionsPatients with BAV are at markedly increased risk of IE and aortic root abscess than patients with TAV. Increased risk of IE in patients with BAV indicates they may be a candidate group for long-term trials of antibiotic prophylaxis of IE.

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Incidence of Infective Endocarditis in Patients With Bicuspid Aortic Valves in the Community

Cited by 52 publications

References 8 publications

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Contemporary natural history of bicuspid aortic valve disease: a systematic review

Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts

Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves

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