In-Hospital and 1-Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis (original) (raw)
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Prosthetic valve endocarditis: predictors of early outcome of surgical therapy. A multicentric study
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2017
Prosthetic valve endocarditis (PVE) is an uncommon yet dreadful complication in patients with prosthetic valves that requires a distinct analysis from native valve endocarditis. The present study aims to investigate independent risk factors for early surgical outcomes in patients with PVE. A retrospective cohort study was conducted in 8 Italian Cardiac Surgery Units from January 2000 to December 2013 by enrolling all PVE patients undergoing surgical treatment. A total of 209 consecutive patients were included in the study. During the study period, the global rate of surgical procedures for PVE among all operations for isolated or associated valvular disease was 0.45%. Despite its rarity this percentage increased significantly during the second time frame (2007-2013) in comparison with the previous one (2000-2006): 0.58% vs 0.31% ( P < 0.001). Intraoperative and in-hospital mortality rates were 4.3% and 21.5%, respectively. Logistic regression analysis identified the following fa...
Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objectives: This study examined the outcomes of surgery for active prosthetic valve endocarditis in a recent decade, with special interest in preoperative treatment and predictors for early and late events. Methods: From 2000 to 2010, a cohort of 149 consecutive patients (mean age, 64 AE 13.9 years; 72% were male) underwent redo-surgery for prosthetic valve endocarditis and were reviewed regarding early (60 days) and late (>60 days) events (death, reinfection, reoperation). Kaplan-Meier survival curves and Cox regression analysis were used to investigate the impact of preoperative intervals and predictors for events, respectively. Results: Preoperative status was critical (European System for Cardiac Operative Risk Evaluation >20%) in 121 patients (81.2%). Staphylococci were the most common infecting microorganisms (27.5%). The median interval between onset of symptoms and diagnosis and between diagnosis and operation was 2 days (interquartile range, 1-5) and 8 days (interquartile range, 2-23), respectively. Operative mortality (30 days) was 12.8%. Mean follow-up was 4 AE 2.9 years. In 53 patients, 47 early (24 deaths, 14 recurrences, 9 reoperations) and 22 late events (11 deaths, 9 recurrences, 2 reoperations) occurred. Overall and event-free survivals at 10 years were 75% AE 3.8% and 64% AE 4.0%, respectively. Freedom from recurrent infection and reoperation at 10 years were 81% AE 3.6% and 91% AE 2.6%, respectively. In multivariate Cox regression, mechanical circulatory support, prolongation between onset of symptoms and diagnosis more than 30 days, and preoperative presence of renal failure predicted early events, and double valve replacement predicted late events. Conclusions: Cardiac and renal function, need for double valve replacement, and preoperative treatment predicted outcomes. A prolonged interval in which patients were left untreated while symptomatic, but not prolongation of preoperative antibiotic treatment, increased risk.
Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases
Heart, 2005
To identify the prognostic markers of a bad outcome in a large population of 104 patients with prosthetic valve endocarditis (PVE), and to study the influence of medical versus surgical strategy on outcome in PVE and thus to identify patients for whom surgery may be beneficial. Design: Multicentre study. Methods and results: Among 104 patients, 22 (21%) died in hospital. Factors associated with in-hospital death were severe co-morbidity (6% of survivors v 41% of those who died, p = 0.05), renal failure (28% v 45%, p = 0.05), moderate to severe regurgitation (22% v 54%, p = 0.006), staphylococcal infection (16% v 54%, p = 0.001), severe heart failure (22% v 64%, p = 0.001), and occurrence of any complication (60% v 90%, p = 0.05). By multivariate analysis, severe heart failure (odds ratio 5.5) and Staphylococcus aureus infection (odds ratio 6.1) were the only independent predictors of in-hospital death. Among 82 in-hospital survivors, 21 (26%) died during a 32 month follow up. A Cox proportional hazards model identified early PVE, co-morbidity, severe heart failure, staphylococcus infection, and new prosthetic dehiscence as independent predictors of long term mortality. Mortality was not significantly different between surgical and non-surgical patients (17% v 25%, respectively, not significant). However, both in-hospital and long term mortality were reduced by a surgical approach in high risk subgroups of patients with staphylococcal PVE and complicated PVE. Conclusions: Firstly, PVE not only carries a high in-hospital mortality risk but also is associated with high long term mortality and needs close follow up after the initial episode. Secondly, congestive heart failure, early PVE, staphylococcal infection, and complicated PVE are associated with a bad outcome. Thirdly, subgroups of patients could be identified for whom surgery is associated with a better outcome: patients with staphylococcal and complicated PVE. Early surgery is strongly recommended for these patients.
Surgery for prosthetic valve endocarditis: a retrospective study of a national registry†
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2017
We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, ...
Cardiology Journal, 2013
Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study. Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treated at 13 major hospitals in Turkey from 2005 to 2012. Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14--6.13), poor functional status (OR 24.5;) and high CRP (OR 1.02; 95% CI 1.00-1.03) measured on admission were independent risk associates for in-hospital mortality Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class of III/IV and high CRP reflected independent risk for stroke/mortality end point. (Cardiol J 2013; 20, 3: 323-328)
Prosthetic valve endocarditis: management strategies and prognosis
Netherlands Heart Journal, 2009
A ten-year analysis in a tertiary care centre in Tunisia Background. Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined. Objective. To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short-and midterm outcome in a tertiary care centre in a developing country (Tunisia). Methods. All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria. Results. A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09). Conclusion. PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach.
Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement
Circulation
CORRESPONDENCE P rosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis and accounts for 20% of all cases of infective endocarditis. 1,2 However, studies reporting the incidence of PVE after surgical aortic valve replacement (AVR) are scarce and based mainly on noncontemporary patient cohorts. Whether PVE affects biological and mechanical aortic valves to the same extent remains unknown. Therefore, we investigated the incidence and risk of PVE after surgical AVR in patients with biological and mechanical valves. This observational, nationwide, population-based cohort study was approved by the regional Human Research Ethics Committee in Stockholm, Sweden (Dnr. 2016/1241-32) and is registered at ClinicalTrials.gov (Unique identifier: NCT02276950). No informed consent from patients was required. The SWEDE-HEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register was used to obtain the study population. The unique personal identity number was used for cross-linking patient-level data from other national healthcare registers as described previously. 3 All patients who underwent AVR with a biological or mechanical valve prosthesis in Sweden from January 1, 1995, to December 31, 2012, were included in the study. Patients with multiple valve surgeries were excluded. Person-time in days was counted from the date of surgery until the date of diagnosis of PVE, death, or end of follow-up (December 31, 2012, for PVE and March 24, 2014, for death). Cox regression was used to estimate the relative risk of PVE. Data management and statistical analyses were performed with Stata version 14.2 (StataCorp LP, College Station, TX). We included 26 580 patients; 16 426 (62%) received a bioprosthesis and 10 154 (38%) received a mechanical valve. Patients with bioprostheses were older (mean age, 74.1 versus 61.0 years) and had more comorbidities than patients with mechanical valves. During a mean follow-up of 6.2 years (maximum, 18.0 years), 940 patients (3.5%) were hospitalized for infective endocarditis. The event rates and crude and adjusted risks for PVE are shown in the Table. The incidence rate of PVE was 0.57% (95% confidence interval [CI], 0.54-0.61) per person-year. The incidence rates of PVE in biological and mechanical valves at 0 to 1, 1 to 5, 5 to 10, and 10 to 15 years' follow-up are shown in the Table. The risk of PVE was higher in patients with bioprostheses, both in the unadjusted analysis (hazard ratio [HR], 1.51; 95% CI, 1.31-1.74) and in the multivariable-adjusted analysis (HR, 1.54; 95% CI, 1.29-1.83). The results were consistent in age-stratified and agematched analyses. The adjusted risk of both early (within 1 year) endocarditis (HR, 1.65; 95% CI, 1.16-2.37) and late endocarditis (HR, 1.53; 95% CI, 1.25-1.86) was higher in patients with bioprostheses. In this nationwide, population-based cohort study, the incidence of PVE after AVR was 0.57% per person-year. The risk of PVE was highest during the first year after AVR; thereafter, the yearly rate of PVE was halved and remained stable during