Arvind K. Agnihotri, MD (by invitation), David C

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Presentation transcript:

The prevalence of infective endocarditis after aortic valve replacement Arvind K. Agnihotri, MD (by invitation), David C. McGiffin, MD (by invitation), Andrew J. Galbraith, MD b(by invitation), Mark F. O'Brien, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 110, Issue 6, Pages 1708-1724 (December 1995) DOI: 10.1016/S0022-5223(95)70035-8 Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 A, Time-related prevalence of freedom fromendocarditis after first AVR at TPCH (n = 2443). Note that the vertical axis representing freedom from endocarditis (the complement of prevalence of endocarditis) is expanded. Circles represent the occurrence of endocarditis in an individual, positioned along the horizontal axis at the interval between operation and the time of occurrence and actuarially (Kaplan-Meier method) along the vertical axis. The vertical bars represent 70% confidence limits (+ standard deviation). Numbers in parentheses represent the number of patients continuing to be followed up after that time. The solid line represents the parametrically estimated freedom from endocarditis, and the dashed line encloses the 70% confidence limits of that estimate. The table represents the parametric estimates at specified intervals. B, Hazard function for therate of endocarditis (events/month) after the first AVR at TPCH. The horizontal axis is expanded for better visualization of the early risk. The hazard function has two phases, an early peaking phase that gives way to the constant phase of hazard at about 5.5 months. The depiction is similar to that in A. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 A, Time-related prevalence of freedom fromendocarditis after first AVR at TPCH (n = 2443). Note that the vertical axis representing freedom from endocarditis (the complement of prevalence of endocarditis) is expanded. Circles represent the occurrence of endocarditis in an individual, positioned along the horizontal axis at the interval between operation and the time of occurrence and actuarially (Kaplan-Meier method) along the vertical axis. The vertical bars represent 70% confidence limits (+ standard deviation). Numbers in parentheses represent the number of patients continuing to be followed up after that time. The solid line represents the parametrically estimated freedom from endocarditis, and the dashed line encloses the 70% confidence limits of that estimate. The table represents the parametric estimates at specified intervals. B, Hazard function for therate of endocarditis (events/month) after the first AVR at TPCH. The horizontal axis is expanded for better visualization of the early risk. The hazard function has two phases, an early peaking phase that gives way to the constant phase of hazard at about 5.5 months. The depiction is similar to that in A. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 Time-related prevalence of freedom from replacement valve endocarditis stratified by presence of previous (preoperative) endocarditis. Symbols represent the occurrence of replacement valve endocarditis in an individual: circles for patients without preoperative endocarditis, squares for patients with remote preoperative endocarditis, and triangles for patients with active preoperative endocarditis. Symbols are positioned along the horizontal axis at the interval between operation and the time of occurrence and actuarially along the vertical axis. Vertical bars represent 70% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Nomograms (specific solutions from the multivariable equation) depicting risk-adjusted freedom from replacement valve endocarditis. Lines shown are specific solutions to the multivariable equation for a 50-year-old patient,without renal dysfunction, and with the preoperative history indicated.The lines represent the overall response for all replacementvalve types. The confidence intervals are not shown to improve clarity, but those for "no preoperative endocarditis" overlapped no others. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4A Nomogram (specific solution from the multivariable equation) depicting risk-adjusted freedom from replacement valve endocarditis (risk adjusted) for a patient receiving a Carpentier-Edwards (xenograft) valve. Estimates were made for a 50-year-old patient, without renal dysfunction, who did not receive aconcomitant aortic root replacement, and with the pre-replacement endocarditis history specified. Solid lines are parametric estimate and dashed lines represent 70% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4B Nomogram (specific solution from the multivariable equation) depicting risk-adjusted freedom from replacement valve endocarditis (risk adjusted) for a patient receiving an allograft valve. Estimates were made for a 50-year-old patient, without renal dysfunction, who did not receive a concomitant aortic root replacement,and with the pre-replacement endocarditis history specified. Solid lines are parametric estimate and dashed lines represent 70% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4C Nomogram (specific solution from the multivariable equation) depicting risk-adjusted freedom from replacement valve endocarditis (risk adjusted) for a patient receiving a St. Jude Medical (mechanical) valve. Estimates were made for a 50-year-old patient, without renal dysfunction, who did not receive a concomitant aortic root replacement, and with the pre-replacement endocarditis history specified. Solid lines are parametric estimate and dashed lines represent 70% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 5 Separately determined hazard functions for the non-risk-adjusted rate of staphylococcal and streptococcal endocarditis. The horizontal axis is expanded to allow better visualization of early phase differences. Solid lines represent the hazard estimates, and the corresponding dashed lines enclose 70% confidence limits. Note that the risk of staphylococcal endocarditis is increased early after the operation and that the constant-phase risk is similar for staphylococcal and streptococcal endocarditis. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1708-1724DOI: (10.1016/S0022-5223(95)70035-8) Copyright © 1995 Mosby, Inc. Terms and Conditions