Author + information
- Darren Mylotte,
- Dinela Rushani,
- Liming Guo,
- Mohammed Kaouache,
- Kenneth Guo,
- Judith Therrien,
- Giuseppe Martucci,
- Andrew Mackie and
- Ariane Marelli
Congenital heart disease (CHD) confers an increased risk of infective endocarditis (IE), though the lesion-specific risk is poorly defined. Furthermore, the contribution of recent valve replacement surgery to IE-risk is unknown.
We used the Quebec CHD database to extract clinical data on adult CHD patients (18-65 years) diagnosed with IE. Patients were classified according to CHD lesion as follows: cyanotic (tetralogy of Fallot, univentricular heart, complete transposition, truncus arteriosus, hypoplastic left heart); endocardial cushion defects; left-sided (coarctation of the aorta, aortic and mitral stenosis/insufficiency); right-sided (Ebstein anomaly, anomalies of the pulmonary artery/valve); ventricular septal defect; atrial septal defect; patent ductus arteriosus; and other CHD (other or unspecified congenital anomalies). A nested case control study was performed and predictors of IE derived using a logistic regression model. Valve replacement surgery was deemed to be recent if it was performed within 6 months of IE diagnosis. Death within 30-days of diagnosis defined IE-related mortality.
Among 29,137 patients with CHD, 459 (1.58%) developed IE during a follow-up period of 335,683 patient years. The median age of IE diagnosis was 43.6 years (30.9, 54.1). The highest and lowest lesion-specific incidences of IE were observed in patients with left sided lesions (2.89% per 1000 patient years) and patent ductus arteriosus (0.3% per 1000 patient years), respectively. Predictors of IE included: male gender [odds ratio (OR) 1.9: 95% confidence interval (CI) 1.5-2.3; p<0.0001], cyanosis (OR 2.7: 95% CI 1.9-4.0, p<0.0001) and left-sided (OR 3.4: 95% CI 2.6-4.6;p<0.0001) lesions, ventricular septal defect (OR 1.7: 95% CI 1.2-2.4;p=0.002) and recent valve replacement surgery (OR 5.7: 95% CI 2.6-12.5;p<0.0001). Right-sided lesions were not associated with IE (OR 0.9: 95% CI 0.5-1.9;p=0.9). IE-related mortality occurred in 26 patients
The risk of IE in CHD patients is lesion specific and is greatest in the context of recent valve replacement surgery. Efforts to reduce IE in the CHD population should focus on these high-risk patient groups.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Valvular Disease in the Adult
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1202-116
- 2013 American College of Cardiology Foundation