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Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population.

Abstract：

BACKGROUND:The prevalence of congenital heart disease (CHD) in the adult population is steadily increasing. A substrate of prosthetic material and residual lesions, constantly evolving as surgical techniques change over time, predispose these patients to the potentially devastating complication of infective endocarditis (IE). METHODS:We retrospectively reviewed 2935 patients in our adult CHD database for all cases of endocarditis between 1991 and 2016. Incidence, clinical course and predictors of outcomes were analysed. RESULTS:We document 74 episodes in 62 patients, with an incidence of 0.9 cases/1000 patient years (py). IE was more common in complex CHD (1.4 cases/1000py) and ventricular septal defects (VSDs) (1.9 cases/1000py). Prosthetic material was involved in 47% and left-sided infection predominated (66%). The incidence in bicuspid aortic valves post aortic valve replacement (AVR) was significantly higher than in unoperated valves, being 1.8 and 1.1 cases/1000 patient years respectively. Streptococcus was the most frequently implicated causative organism (37%). Emboli occurred in 34% of cases with a cerebral predilection. 46% of patients required surgery during the admission for IE, most frequently to replace a severely regurgitant bicuspid aortic valve. Early endocarditis-related mortality was 15%, associated with cerebral emboli and acute renal failure. CONCLUSIONS:In a contemporary adult CHD cohort, those with complex underlying lesions, VSDs or an AVR were at higher risk for IE. Mortality remains substantial and is more likely in patients with cerebral emboli and/or acute renal failure.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Moore B,Cao J,Kotchetkova I,Celermajer DS

doi

10.1016/j.ijcard.2017.08.035

subject

Has Abstract

pub_date

2017-12-15 00:00:00

pages

161-165

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(17)32410-5

journal_volume

249

pub_type

杂志文章

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