Surgical results for prosthetic versus native valve endocarditis: A multicenter analysis

Weber, Carolyn; Petrov, Georgi; Luehr, Maximilian; Aubin, Hug; Tugtekin, Sems Malte; Borger, Michael A.; Akhyari, Payam; Wahlers, Thorsten; Hagl, Christian; Matschke, Klaus; Misfeld, Martín

doi:10.1016/j.jtcvs.2019.09.186

Cited by 27 publications

(30 citation statements)

References 28 publications

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“…Ischaemic stroke is a well-known complication soon after heart surgery, with occurrence ranging from 4% to 16% in IE patients receiving heart surgery. 8,16 Moreover, as our group has previously demonstrated, IE patients after SAVR with biological prosthesis are at increased risk of IS in the long term, when compared to patients with mechanical aortic valve prostheses. 17 Furthermore, IE patients with mechanical aortic valve prosthesis also had better 5-year survival than patients treated with biological prosthesis.…”

Section: Discussionmentioning

confidence: 82%

“…Also, a recent analysis by Luehr and colleagues showed a 33% mortality of IE patients treated with first‐time SAVR 12 . The survival rate is considerably worse after valve surgery in patients with prosthetic valve IE compared to patients with native‐valve IE, as shown by Weber et al in their retrospective multicentre study from Germany 16 . Our results are in line with these findings, indicating that patients with IE have increased risk for mortality even after successful initial treatment of the disease.…”

Section: Discussionmentioning

confidence: 92%

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Surgical aortic valve replacement and infective endocarditis

Malmberg

Ahtela

Sipilä

et al. 2020

Eur J Clin Investigation

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Native-valve infective endocarditis (IE) is a serious, life-threatening disease associated with high mortality and morbidity. [1][2][3] Antimicrobial therapy together with surgical intervention is the main treatment option. [4][5][6] Surgical treatment of IE patients can be challenging. Technical aspects of the procedure can be difficult, operative mortality is increased, and the mid-term results are impaired compared to conventional valve surgery without IE. 7,8 There are only few

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 92%

Surgical aortic valve replacement and infective endocarditis

Malmberg

Ahtela

Sipilä

et al. 2020

Eur J Clin Investigation

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“…In the early onset group the most common infective agent was Staphylococcus aureus , whereas in the late group the most common agent was Enterococcus faecalis . Moreover, infection with S. aureus is the leading cause of PVE in most epidemiologic studies and represents a high-risk subgroup in this population [ 25 , 26 ]. On the other hand, other authors reported S. epidermidis as the most frequent causative microorganism [ 7 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Overall mortality in our study was 16.67%, which is comparable with data from other studies. A meta-analysis by Mihos et al [ 5 ] and a multicentre analysis from Germany [ 25 ] reported 30-day mortality of 25% and 19.6% respectively. The mortality in patients in our study with early PVE was almost twice as high (13.04% vs. 23.08%) compared with late PVE.…”

Section: Discussionmentioning

confidence: 99%

Valve-related factors and incidence of prosthetic valve endocarditis

Bezak

Artemiou

Hulman

2020

kitp

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Aim The aim of the study was to present our experience and evaluate the valve-related factors and the incidence of prosthetic valve endocarditis. Material and methods This is a retrospective study. Between 2010 and 2018, 36 patients were re-operated on due to prosthetic valve endocarditis The valve-related factors (type, size and position of the prosthetic valve) were analysed. Results Thirty-six patients had prosthetic valve endocarditis. The overall hospital mortality was 16.67%. Early vs. late onset prosthetic valve endocarditis mortality was 23.08% vs. 13.04% respectively. The type, size or position of the prosthesis was not associated with prosthetic valve endocarditis. There was a statistically significant difference between occurrence of prosthetic infection between mitral repair and replacement both in mechanical and biological valve groups. The most common infective agent in the early onset group was Staphylococcus aureus, whereas in the late onset group it was Enterococcus faecalis. Out of 13 patients with early prosthetic valve endocarditis, 11 had infection in the perioperative period around primary operation. Conclusions Based on our experience, prosthetic valve endocarditis has a high mortality. Early onset prosthetic valve endocarditis is less common but has higher mortality compared to the late onset. Mitral valve repair was less prone to develop prosthetic valve endocarditis, and valve-related factors (type and size of the valve, valve position) did not have any influence on the incidence of prosthetic valve endocarditis.

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“…Among patients undergoing valve operation for infective endocarditis (IE), surgery for prosthetic valve endocarditis (PVE) has been associated with distinct mortality rates in cardiothoracic surgery [1][2][3]. PVE accounts for 10-30% of all cases of IE and occurs in 1-6% of patients with valve prostheses [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis

Weber

Rahmanian²,

Nitsche

et al. 2020

BMC Cardiovasc Disord

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Background: Cardiac surgery for prosthetic valve endocarditis (PVE) is associated with substantial mortality. We aimed to analyze 30-day and 1-year outcome in patients undergoing surgery for PVE and sought to identify preoperative risk factors for mortality with special regard to perivalvular infection. Methods: We retrospectively analyzed data of 418 patients undergoing valve surgery for infective endocarditis between January 2009 and July 2018. After 1:1 propensity matching 158 patients (79 PVE/79 NVE) were analyzed with regard to postoperative 30-day and 1-year outcomes. Univariate and multivariable analyses were performed to identify potential risk factors for mortality. Results: 315 patients (75.4%) underwent surgery for NVE and 103 (24.6%) for PVE. After propensity matching groups were comparable with regard to preoperative characteristics, clinical presentation and microbiological findings, except a higher incidence of perivalvular infection in patients with PVE (51.9%) compared to NVE (26.6%) (p = 0.001), longer cardiopulmonary bypass (166 [76-130] vs. 97 [71-125] min; p < 0.001) and crossclamp time (95 [71-125] vs. 68 [55-85] min; p < 0.001). Matched patients with PVE showed a 4-fold increased 30-day mortality (20.3%) in comparison with NVE patients (5.1%) (p = 0.004) and 2-fold increased 1-year mortality (PVE 29.1% vs. NVE 13.9%; p = 0.020). Multivariable analysis revealed perivalvular abscess, sepsis, preoperative AKI and PVE as independent risk factors for mortality. Patients with perivalvular abscess had a significantly higher 30-day mortality (17.7%) compared to patients without perivalvular abscess (8.0%) (p = 0.003) and a higher rate of perioperative complications (need for postoperative pacemaker implantation, postoperative cerebrovascular events, postoperative AKI). However, perivalvular abscess did not influence 1-year mortality (20.9% vs. 22.3%; p = 0.806), or long-term complications such as readmission rate or relapse of IE. Conclusions: Patients undergoing surgery for PVE had a significantly higher 30-day and 1-year mortality compared to NVE. After propensity-matching 30-day mortality was still 4-fold increased in PVE compared to NVE. Patients with perivalvular abscess showed a significantly higher 30-day mortality and perioperative complications, whereas perivalvular abscess seems to have no relevant impact on 1-year mortality, the rate of readmission or relapse of IE.

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Surgical results for prosthetic versus native valve endocarditis: A multicenter analysis

Cited by 27 publications

References 28 publications

Surgical aortic valve replacement and infective endocarditis

Surgical aortic valve replacement and infective endocarditis

Valve-related factors and incidence of prosthetic valve endocarditis

Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis

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