Circulation, Vol 72, 31-37, Copyright © 1985 by American Heart Association
SB Calderwood, LA Swinski, CM Waternaux, AW Karchmer and MJ Buckley
Risk factors for the development of prosthetic valve endocarditis (PVE)
were analyzed in 2642 patients undergoing initial valve replacement at the
Massachusetts General Hospital from 1975 to 1982. Follow-up was available
for 2608 patients (98.7%); the mean length of follow-up was 39.8 months.
PVE developed in 116 patients (4.4%). The actuarial risk of PVE was 3.1% at
12 months and 5.7% at 60 months. A Cox model was used to identify risk
factors for PVE. Recipients of multiple valves had a higher risk of PVE
than single valves (p = .01). There was no difference in the risk of PVE
for patients receiving aortic valves vs those receiving mitral valves.
Recipients of mechanical valves had a higher risk of PVE than recipients of
porcine valves in the first 3 months after surgery (p = .02), but the risk
of PVE was higher for porcine valve recipients 12 months or more after
surgery (p = .004). Despite this difference in the time course of
development of PVE, there was no significant difference in the cumulative
risk of PVE by 5 years of follow-up between mechanical and porcine valve
recipients. Male sex was a risk factor for PVE within 12 months of aortic
valve replacement (p = .008) but not thereafter; sex did not influence the
risk of PVE after mitral valve replacement. Older patients had a higher
risk of late PVE after multiple (p = .04) or mitral valve replacement (p =
.08), but not after aortic valve replacement.
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