Patient and Surgeon Predictors of Mitral and Tricuspid Valve Repair for Infective Endocarditis

Brescia, Alexander A.; Watt, Tessa M.F.; Rosenbloom, Liza M; Williams, Aaron M.; Bolling, Steven F.; Romano, Matthew A.

doi:10.1053/j.semtcvs.2021.03.017

Cited by 8 publications

(9 citation statements)

References 34 publications

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“…Our results highlighted the negative prognostic impact of infective endocarditis which is underscored by the persistently high mortality rate in the first 3–6 months after surgery with a survival at 10 years of 68% after mitral valve repair and 63% after mitral valve replacement. These outcome findings are confirmed by previous large cohort studies of patients 2,3,16 and are well below the survival probabilities (higher than 90%) that have been described for degenerative mitral disease 17,18 …”

Section: Discussionsupporting

confidence: 86%

“…The yellow area (-0.1; 0.1) defines an interval of acceptable differences. 15 13 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] 15 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] 11 [8][9][10][11][12][13][14][15][16][17][18][19] 0.013 compares well with recent data from national registries and high-volume centres' experiences reporting an average rate of early death ranging from 3% to 12%. [1][2][3][4] Patients with infection present a systemic involvement and are burdened by the occurrence of local and peripheral complications that account for the increased surgical risks.…”

Section: Recent Cerebral Strokesupporting

confidence: 62%

“…Not surprisingly, valve replacement is still the most common surgery for mitral valve infective endocarditis, as national registries report that mitral repair is performed in approximately 20–30% of the cases 1,2,21 . A higher rate of valve repair – up to 50–70% of mitral infective endocarditis cases – has been associated with the practice of specialist mitral surgeons and in the context of comprehensive valve centres 3,11,16 . However, the repair cohorts in these studies had a lower proportion of acute endocarditis and urgent cases, 22 included younger patients with a lower prevalence of cardiogenic shock and chronic renal failure 16 and limited tissue destruction 3 …”

Section: Discussionmentioning

confidence: 99%

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Surgical repair and replacement for native mitral valve infective endocarditis

Malvindi,

Luthra,

Zingale

et al. 2024

Journal of Cardiovascular Medicine

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Aims The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Methods Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001–2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients’ profile between the repair and replacement subgroups. Results Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Conclusions Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.

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Section: Discussionsupporting

confidence: 86%

Section: Recent Cerebral Strokesupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Surgical repair and replacement for native mitral valve infective endocarditis

Malvindi,

Luthra,

Zingale

et al. 2024

Journal of Cardiovascular Medicine

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“…Mitral valve surgery requires bicaval cannulation, a transatrial and/or transseptal access route, and is not routinely performed by all cardiac surgeons-especially when reconstruction of the valve might be an option. 14 But once operated and discharged, Streptococcus patients showed the lowest mortality rates at 1 and 5 years, most likely due to their significantly lower age with the lowest incidences of the independent risk factors diabetes and preoperative dialysis. At 1 and 5 years, the mortality rates were significantly higher in the Staphylococcus group.…”

Section: Discussionmentioning

confidence: 99%

“…This might be partly explained by the fact that patients with Streptococcus infection had the highest incidence of double valve endocarditis and an equally high rate of mitral valve endocarditis compared with the Staphylococcus group. Mitral valve surgery requires bicaval cannulation, a transatrial and/or transseptal access route, and is not routinely performed by all cardiac surgeons—especially when reconstruction of the valve might be an option 14. But once operated and discharged, Streptococcus patients showed the lowest mortality rates at 1 and 5 years, most likely due to their significantly lower age with the lowest incidences of the independent risk factors diabetes and preoperative dialysis.…”

Section: Discussionmentioning

confidence: 99%

Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis

et al. 2022

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Objective: Infective endocarditis (IE) caused by Staphylococcus species (spp.) is believed to be associated with higher morbidity and mortality rates. We hypothesize that Staphylococcus spp. are more virulent compared with other commonly causative bacteria of IE with regard to shortterm and long-term mortality. Background: It remains unclear if patients suffering from IE due to Staphylococcus spp. should be referred for surgical treatment earlier than other IE patients to avoid septic embolism and to optimize perioperative outcomes. Materials and Methods: The database of the CAMPAIGN registry, comprising 4917 consecutive patients undergoing heart valve surgery, was retrospectively analyzed. Patients were divided into 2 groups with regard to the identified microorganisms: Staphylococcus group and the non-Staphylococcus group. The non-Staphylococcus group was subdivided for further analyses: Streptococcus group, Enterococcus group, and all other bacteria groups. Results: The respective mortality rates at 30 days (18.7% vs 11.8%; P < 0.001), 1 year (24.7% vs 17.7%; P < 0.001), and 5 years (32.2% vs 24.5%; P < 0.001) were significantly higher in Staphylococcus patients (n = 1260) compared with the non-Staphylococcus group (n = 1787).Multivariate regression identified left ventricular ejection fraction <30% (P < 0.001), chronic obstructive pulmonary disease (P = 0.045), renal insufficiency (P = 0.002), Staphylococcus spp. (P = 0.032), and Streptococcus spp. (P = 0.013) as independent risk factors for 30-day mortality. Independent risk factors for 1-year mortality were identified as: age (P < 0.001), female sex (P = 0.018), diabetes (P = 0.018), preoperative stroke (P = 0.039), chronic obstructive pulmonary disease (P = 0.001), preoperative dialysis (P < 0.001), and valve vegetations (P = 0.004). Conclusions: Staphylococcus endocarditis is associated with an almost twice as high 30-day mortality and significantly inferior long-term outcome compared with IE by other commonly causative bacteria. Patients with Staphylococcus infection are more often female and critically ill, with > 50% of these patients suffering from clinically relevant septic embolism. Early diagnosis and referral to a specialized center for surgical treatment are strongly recommended to reduce the incidence of preoperative deterioration and stroke due to septic embolism.

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Tricuspid valve repair and replacement for infective endocarditis

Galeone,

Gardellini,

Perrone

et al. 2023

Indian J Thorac Cardiovasc Surg

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Infective endocarditis represents a challenging and life-threatening clinical condition affecting native and prosthetic heart valves, endocardium, and implanted cardiac devices. Right-sided infective endocarditis account for approximately 5–10% of all infective endocarditis and are often associated with intravenous drug use, intracardiac devices, central venous catheters, and congenital heart disease. The tricuspid valve is involved in 90% of right-side infective endocarditis. The primary treatment of tricuspid valve infective endocarditis is based on long-term intravenous antibiotics. When surgery is required, different interventions have been proposed, ranging from valvectomy to various types of valve repair to complete replacement of the valve. Percutaneous removal of vegetations using the AngioVac system has also been proposed in these patients. The aim of this narrative review is to provide an overview of the current surgical options and to discuss the results of the different surgical strategies in patients with tricuspid valve infective endocarditis.

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Patient and Surgeon Predictors of Mitral and Tricuspid Valve Repair for Infective Endocarditis

Cited by 8 publications

References 34 publications

Surgical repair and replacement for native mitral valve infective endocarditis

Surgical repair and replacement for native mitral valve infective endocarditis

Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis

Tricuspid valve repair and replacement for infective endocarditis

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