Endocarditis infecciosa sobre válvula aórtica bicúspide: características clínicas, complicaciones y pronóstico

espanolIntroduccion La valvula aortica bicuspide (VAB) es la malformacion cardiaca congenita mas frecuente. Se asocia a un mayor riesgo de complicaciones cardiovasculares, entre las que se incluye la endocarditis infecciosa (EI). Metodos Estudio observacional, unicentrico de cohorte, que incluye de forma prospectiva a todos los pacientes ingresados por EI entre 1996 y 2014. Se analizan datos epidemiologicos, clinicos, microbiologicos, ecocardiograficos, complicaciones durante la hospitalizacion, necesidad quirurgica, mortalidad intrahospitalaria y seguimiento a un ano. Se excluyen los casos con endocarditis sobre valvulas protesicas o en otras localizaciones, y aquellos de cuya valvula aortica no se tienen datos certeros acerca de su morfologia. Se ha realizado un analisis estadistico comparativo entre VAB y tricuspide (VAT). Resultados De un total de 328 casos con EI, 118 (35,67%) fueron sobre valvula aortica. Tenian VAB 18 (16,22%). Los casos con VAB eran mas jovenes que los portadores de VAT (51±19,06 vs. 60,83±15,73 anos, p=0,021) y tenian menos comorbilidad (indice de Charlson 0,67±0,77 vs. 1,44±1,64, p=0,03). En el grupo con VAB observamos tendencia a EI causada por Staphylococcus spp. (38,9 vs. 21,5%, p=0,137). Con diferencia estadistica, hubo mas complicaciones perivalvulares entre los casos con VAB (55,6% vs. 16,1%, p=0,001) predominando los abscesos (38,9 vs. 16,1%, p=0,047). Ser portador de VAB fue el unico factor predictor de las mismas (OR 7,87, IC del 95%, 2,38-26,64, p=0,001). Los pacientes con VAB se operaron mas (83,3 vs. 44,1%, p=0,004) y la mortalidad durante el ingreso hospitalario fue menor, aunque no alcanzo significacion estadistica (5,6 vs. 25,8%, p=0,069). La supervivencia a un ano fue significativamente superior en el grupo de VAB (93,8 vs 69,3%, p=0,048). Conclusiones Los pacientes con EI sobre VAB son jovenes, con poca comorbilidad asociada. Tienen frecuentemente complicaciones perivalvulares por lo que requieren cirugia precoz. La mortalidad intrahospitalaria comparada con EI sobre VAT es menor y la supervivencia a un ano es significativamente mayor. EnglishIntroduction Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE). Methods Retrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV). Results Of a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38–26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048). Conclusions Patients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher.