Long-term clinical results after combined aortic and mitral valve replacement

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Abstract
To study the incidence and risk factors of prosthetic valve endocarditis(PVE) we followed 99.5% of 912 patients who had valve replacements from 1January 1981 to 31 December 1985 for 1-6 (mean 3) years. PVE occurred in 27patients (2.96% or 0.98% per patient-year). The incidence of PVE in theaortic position (3.9%) was significantly higher than in the mitral position(1.5%): chi-square = 6.1, P less than 0.025. PVE developed in 19 of 329patients with bioprostheses (5.8%), and in 8 of 583 patients withmechanical valves (1.4%): chi- square = 14.48, P less than 0.005).Actuarially at 5-year follow-up, 90.7% +/- 2.16% of the bioprosthetic groupand 98.4% +/- 0.56% of the mechanical valve group was free of PVE (P lessthan 0.001). Antecedent endocarditis increased both the incidence andrelative risk of PVE 7- fold compared to patients without antecedentendocarditis (chi-square = 32.0, P less than 0.0001). Bioprosthetic valvereplacement in infective endocarditis increased the risk of PVE 12-foldcompared to valve replacement by mechanical prostheses. In conclusion: inthe order of importance, antecedent endocarditis, bioprostheses and aorticposition are risk factors in the development of PVE. Bioprosthesesimplanted in patients with antecedent endocarditis further enhance the riskof PVE.

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