Bachour, Khaled, Zmily, Hammam, Kizilbash, Mohammad, Awad, Khaled, Hourani, Rayan, Hammad, Hazem, Sobel, Jack D., Ghali, Jalal K., Levine, Donald, and Afonso, Luis
BACKGROUND: Left‐sided native valve infective endocarditis (LNVIE) can result in mitral (MP) and aortic (AP) valve perforation, the prognostic significance of which remains poorly defined. HYPOTHESIS: Valvular perforation is associated with worse outcomes. METHODS: Retrospective review of patients with LNVIE during 1998–2005 was performed to examine characteristics and outcome predictors of LNVIE complicated by valve perforation. Patients were stratified as: group A: MP or AP detected by transesophageal echocardiography (TEE) or surgery; group B: no TEE evidence of MP or AP. RESULTS: A total of 123 patients were included (group A = 47, group B = 76). In group A, 35 patients (74.5%) had MP alone, 11 (23.4%) had AP alone, and 1 patient had both. Severe valvular insufficiency was encountered more in group A (85.1% versus 59.2%, p = 0.003), so was hemodialysis (40.4% versus 17.1%, p = 0.004) and indications for valvular surgery (93.6% versus 77.6%, p = 0.02). Group A had a higher rate of in‐hospital death (31.9% versus 15.8%, p = 0.04). Among patients who had an indication for valvular surgery, the in‐hospital mortality rate for those who underwent valvular surgery was 16.7% in group A, and 7.9% in group B (p = 0.4), compared to those who did not undergo surgery (71.4% versus 33.3%, p = 0.04). Amongst survivors, hospital stay was on average 9.2 d longer in group A (38.9 versus 29.7 d, p = 0.05). Univariate analysis revealed association between lower survival and valvular perforation (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.17–0.95), that was lost after adjusting for hemodialysis. CONCLUSIONS: Valve perforation complicating LNVIE is associated with hemodialysis, severe valvular insufficiency, and significant morbidity and mortality. Compared to conservative management, early surgical intervention is associated with improved survival. Copyright © 2009 Wiley Periodicals, Inc.