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Native vs Prosthetic/Device Endocarditis: A Comparative Analysis
Session:
Sessão de Posters 24 - Endocardite infeciosa: estratificação de risco, tratamento e desfechos
Speaker:
Joana Filipa Guerreiro Pereira
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Joana Guerreiro Pereira; Joana Massa Pereira; Sofia Andraz; Lucas Hamann; Raquel Menezes Fernandes; Pedro de Azevedo; Jorge Mimoso
Abstract
<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Introduction: </span></strong><span style="font-family:"Times New Roman",serif">Infective endocarditis (IE) in prosthetic valves or cardiac devices (PV/D-IE) is increasingly prevalent and often perceived as more severe than native-valve IE (NV-IE). </span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Purpose: </span></strong><span style="font-family:"Times New Roman",serif">To compare EI patients with or without PV/D regarding clinical characteristics, management and outcomes.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods: </span></strong><span style="font-family:"Times New Roman",serif">Retrospective analysis of patients diagnosed with IE between January 2017 and December 2024 in our Hospital. Patients were stratified as NV-IE or PV/D-IE. Clinical characteristics, microorganisms, complications, organ support, surgical management and outcomes were assessed. Group differences were evaluated and Cox regression explored predictors of mortality.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Results:</span></strong><span style="font-family:"Times New Roman",serif"> Among 87 patients with a median age of 62,7 years-old, 73 had NV-IE (84%) and 14 had PV/D-IE</span><span style="font-family:"Times New Roman",serif"> </span><span style="font-family:"Times New Roman",serif">(16%; of which 10 patients with PV-IE, 2 with D-IE and 2 with mixed PV+D-IE).<strong> </strong>PV/D-IE patients had more coronary artery disease (21% vs 3%,p=0.006), rheumatic heart disease (14% vs 1%, p=0.015) and peripheral artery disease (21% vs 5%,p=0.044).</span><span style="font-size:8.0pt"> </span><em><span style="font-family:"Times New Roman",serif">Staphylococcus aureus</span></em><span style="font-family:"Times New Roman",serif"> predominated in both groups (61% vs 46%,p=0.43).PV/D-IE showed a higher Euroscore II (23.5% vs 3.5%,p<0.001) and higher rates of abscess/fistula (54% vs 19%,p=0.007).Surgery was performed more frequently in PV/D-IE (64% vs 37%,p=0.057).There were no significant differences between groups regarding reoperation (33% vs 13%,p=0.14), recurrence (0% vs 12%,p=0.33), rehospitalization (44% vs 31%,p=0.43), or overall mortality (71% vs 51%,p=0.15), which remained high. In multivariable analysis, PV/D-IE was borderline significantly associated with increased mortality (HR 3.24,95%CI 1.00–10.43,p=0.049), along with Charlson index ≥3, shock, continuous dialysis, and need for non-invasive ventilation. Surgery was strongly protective (HR 0.18,95%CI 0.07–0.42,p<0.001). The interaction analysis between surgery and PV/D-IE was not significant (HR 4.01,95% CI 0.70–22.9,p=0.119), suggesting similar benefit of surgery in both subgroups.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusions: </span></strong><span style="font-family:"Times New Roman",serif">Compared with NV-IE, PV/D-IE affects more comorbid patients and is associated with more invasive complications. Although all-cause mortality did not differ, PV/D-IE was independently associated with higher adjusted mortality. Surgical treatment remained the strongest protective factor across groups and no differential effect was observed in PV/D-IE. These findings highlight the need for early recognition and standardized Heart-Team assessment, particularly in patients with prosthetic heart material.</span></span></span></p>
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