Who Is Most Susceptible to Aortic Valve Endocarditis?

Objectives: Endocarditis is on the rise. Little is known regarding the specific risk of different comorbidities. We thus performed a retrospective study on 1,034 patients.

Methods: Between 2011 and 2019, a total of 1,034 patients (67.1% male, mean: 69.8 years; 32.9% female, mean: 72.2 years) were enrolled receiving four different, widely used stented biological valves (Perimount [N = 340], crown [N = 340], trifecta [N = 250], and Perceval [N = 104] with or without concomitant CABG, atrial ablation, left atrial appendage closure, or wrapping of the ascending aorta. Double or triple valve procedures as well as concomitant prosthetic aortic procedures were excluded. 105 patients were identified presenting with endocarditis. Odds ratios (OR) for the development of endocarditis were calculated regarding co-morbidities as potential risk factors. Statistical analysis was performed using SPSS.

Result: The risk to develop an endocarditis was significantly increased in patients with preoperative atrial fibrillation (OR: 2.056; p = 0.002), decompensation prior to admission (OR: 2.331; p = 0.009), pacemaker carrier (OR: 3.258; p < 0.001), preexisting aortic valve prosthesis (OR: 55.178; p < 0.001); drug-port carrier (OR: 101.74; p < 0.001), dialysis (OR: 5.435; p = 0.039), liver cirrhosis (OR: 6.302; p < 0.001), and depression (OR: 4.261; p = 0.001). Smokers (1.525; p = 0.159) and patients with diabetes mellitus (OR: 1.355; p = 0.164) also demonstrated a nonsignificantly increased risk.

Conclusion: Among the typical risk factors, pacemaker carriers were identified. These patients are currently not considered to be a high-risk group and are thus not recommended to receive endocarditis prophylaxis according to the current guidelines. However, they may be addressed as such. Patients with a prosthetic valve but also those with a drug-port demonstrate an exorbitant risk pointing toward the necessity of a meticulous endocarditis prophylaxis. Patients with a port may even be considered for removal surgery as soon as the treatment administered through the port has ended. This, however, is currently also not recommended.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021