A standardized approach to treat complex aortic valve endocarditis: a case series

Gomes, Anna; Jainandunsing, Jayant S.; Assen, Sander van; Geel, Peter Paul van; Sinha, Bhanu; Gelsomino, Sandro; Johnson, Dan

doi:10.1186/s13019-018-0715-8

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…In addition, the proximity of the aortic valve to the left and right bundle branches means that extension of infection through the aortic valve has a greater likelihood of development of high-grade heart block compared with mitral valve involvement 13. Lastly, studies have shown that early surgical intervention is associated with reduced mortality and reduced risk of embolic events compared with medical management in patients with endocarditis 14 15. One multicenter cohort study has demonstrated that surgery conveyed a significant benefit in mortality in patients with Staphylococcus aureus endocarditis, the most common bacterium indicated in IE today 15.…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Outcomes and Prevalence of Comorbidities in Patients with Infective Endocarditis with and without Heart Blocks: Insight from the National Inpatient Sample

Jamal

Kichloo²,

Albosta

et al. 2021

Journal of Investigative Medicine

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Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

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Section: Discussionmentioning

confidence: 99%

In-Hospital Outcomes and Prevalence of Comorbidities in Patients with Infective Endocarditis with and without Heart Blocks: Insight from the National Inpatient Sample

Jamal

Kichloo²,

Albosta

et al. 2021

Journal of Investigative Medicine

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“…When comparing groups of survivor and non-survivor, the operation, XC, and CPB times were longer in non-survivor group (operation duration (minutes) 323.5 ± 138.1 vs. 245.4 ± 106.4; XC (minutes) 112.3 ± 57.5 vs. 89.7 ± 42.1; CPB (minutes) 202.2 ± 108.3 vs. 139.2 ± 70.4, respectively). 9 Gomes et al 19 and Mistiaen 20 have found the relation between the performed operation, operation time, and the risk of postoperative mortality in patients with IE complicated by septic shock in both the native and prosthetic valve IE. However, the optimal timing of surgery remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Predictors of early mortality after surgical treatment of infective endocarditis: a single-center experience

et al. 2019

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Objective: Surgical management of infective endocarditis continues to be challenging and is associated with significant morbidity and mortality. The objective of our study was to determine the risk factors and conditions associated with poor early infective endocarditis surgical treatment outcomes—30-day postoperative mortality. Methods: A total of 124 patients who underwent surgery for infective endocarditis at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from January 2010 to December 2017 were retrospectively included in this study. The primary endpoints were 30-day postoperative mortality and identification of risk factors associated with it. Secondary endpoints were early postoperative outcomes and complication rates. Results: During the study period, 124 patients with infective endocarditis underwent cardiac surgery, presenting an overall 30-day postoperative mortality rate of 10.48%. Mean age was 58 ± 14.4 years with 95 (76.61%) males. Independent predictive factors of early mortality were age >63 years (odds ratio = 6.4, 95% confidence interval = 1.66-24.66, p = 0.003), body mass index >30 kg/m² (odds ratio = 7.74, 95% confidence interval = 2.20-27.27, p = 0.003), and ischemic heart disease (odds ratio, 6.6, 95% confidence interval = 1.62-26.90, p = 0.003), as well as intraoperative parameters—prolonged aortic cross-clamp >84.5 minutes (odds ratio = 3.79, 95% confidence interval = 1.10-13.08, p = 0.03) and cardiopulmonary bypass time >107.5 minutes (odds ratio = 10.0, 95% confidence interval = 1.26-79.58, p = 0.023). Staphylococcus aureus infection (odds ratio = 5.04, 95% confidence interval = 1.29-19.64, p = 0.012), infective endocarditis–related intracardiac complication such as paravalvular abscess detected by transesophageal echocardiography (odds ratio = 4.32, 95% confidence interval = 1.31-14.25, p = 0.01), and infective endocarditis complicated by septic or cardiogenic shock (odds ratio, 18.43, 95% confidence interval = 4.59-73.98, p = 0.001) were statistically significant factors for increased risk of 30-day postoperative mortality. Conclusion: Surgical treatment of infective endocarditis showed good results in our center. The independent predictors of 30-day postoperative mortality for patients who underwent cardiac surgery for infective endocarditis were age, body mass index, ischemic heart disease, prolonged aortic cross-clamp and cardiopulmonary bypass time, Staphylococcus aureus infection, paravalvular abscess, and septic or cardiogenic shock.

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“…The superior outcomes in our study may be related to the management of our patients in a high-volume heart valve center with a multidisciplinary endocarditis team approach [ 22 ]. Early surgical treatment of complicated endocarditis improves outcomes when compared to medical therapy alone, and it can result in the reduction of 6-month mortality from 33 to 16% [ 23 ]. Furthermore, Perrotta et al [ 9 ] report that aortic PVE is associated with a high rate of early complications and early mortality; however, patients who survive the immediate postoperative period demonstrate satisfactory long-term survival.…”

Section: Commentmentioning

confidence: 99%

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Saha

Ali

Schnackenburg

et al. 2022

JCM

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Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020. Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

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A standardized approach to treat complex aortic valve endocarditis: a case series

Cited by 13 publications

References 23 publications

In-Hospital Outcomes and Prevalence of Comorbidities in Patients with Infective Endocarditis with and without Heart Blocks: Insight from the National Inpatient Sample

In-Hospital Outcomes and Prevalence of Comorbidities in Patients with Infective Endocarditis with and without Heart Blocks: Insight from the National Inpatient Sample

Predictors of early mortality after surgical treatment of infective endocarditis: a single-center experience

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

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