Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock

Krajinović, Vladimir; Ivancic, Stipe; Gezman, Petar; Baršić, Bruno

doi:10.1097/shk.0000000000001013

Cited by 30 publications

(26 citation statements)

References 34 publications

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“…Our findings are of clinical interest since it implicates a possible role for the systemic inflammation associated with sepsis in aggravating AV stenosis. The AV disease commonly associated with sepsis is infective endocarditis, characterized by intensive inflammation in the affected valve cusps . However, we now show that LPS‐induced acute systemic inflammation—a model mimicking sepsis, but without infection—leads to increased AV thickness, but without marked infiltration of inflammatory cells.…”

Section: Discussionmentioning

confidence: 72%

Short‐term LPS induces aortic valve thickening in ApoE*3Leiden mice

Broekhoven

Krijnen

Fuijkschot

et al. 2019

Eur J Clin Investigation

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Background Recently, it was shown that 12 weeks of lipopolysaccharide (LPS) administration to nonatherosclerotic mice induced thickening of the aortic heart valve (AV). Whether such effects may also occur even earlier is unknown. As most patients with AV stenosis also have atherosclerosis, we studied the short‐term effect of LPS on the AVs in an atherosclerotic mouse model. Methods ApoE*3Leiden mice, on an atherogenic diet, were injected intraperitoneally with either LPS or phosphate buffered saline (PBS), and sacrificed 2 or 15 days later. AVs were assessed for size, fibrosis, glycosaminoglycans (GAGs), lipids, calcium deposits, iron deposits and inflammatory cells. Results LPS injection caused an increase in maximal leaflet thickness at 2 days (128.4 µm) compared to PBS‐injected mice (67.8 µm; P = 0.007), whereas at 15 days this was not significantly different. LPS injection did not significantly affect average AV thickness on day 2 (37.8 µm), but did significantly increase average AV thickness at day 15 (41.6 µm; P = 0.038) compared to PBS‐injected mice (31.7 and 32.3 µm respectively). LPS injection did not affect AV fibrosis, GAGs and lipid content. Furthermore, no calcium deposits were found. Iron deposits, indicative for valve haemorrhage, were observed in one AV of the PBS‐injected group (a day 2 mouse; 9.1%) and in five AVs of the LPS‐injected group (both day 2‐ and 15 mice; 29.4%). No significant differences in inflammatory cell infiltration were observed upon LPS injection. Conclusion Short‐term LPS apparently has the potential to increase AV thickening and haemorrhage. These results suggest that systemic inflammation can acutely compromise AV structure.

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Section: Discussionmentioning

confidence: 72%

Short‐term LPS induces aortic valve thickening in ApoE*3Leiden mice

Broekhoven

Krijnen

Fuijkschot

et al. 2019

Eur J Clin Investigation

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“…In Croatia, two recent IE series totaling 324 patients have been published [14] , [15] . The mean patient age ranged 54.5 to 63 years old.…”

Section: Resultsmentioning

confidence: 99%

Endocarditis in the Mediterranean Basin

Gouriet¹,

Chaudet

Pellegrin

et al. 2018

New Microbes and New Infections

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Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45–93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture–negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases.

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“…The endocarditis recurrence rate of our cohort is lower than those reported by other literature regardless of the type of prosthetic valve, 24‐26 which can be explained by the patient characteristics, such as less dialysis dependence, intravenous drug abuse, and the type of pathogen. These factors are proved to be the main independent predictors of recurrent endocarditis 5,27 . Complications associated with anticoagulation, such as stroke and major bleeding events, are still higher in mechanical groups as usual.…”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

Jiang

Xie

et al. 2020

Clinical Cardiology

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Background: The optimal choice of the valve prosthesis in mitral valve replacement (MVR) for infective endocarditis (IE) is controversial and challenging, particularly for younger patients. Hypothesis: The postoperative outcomes of mechanical and biological MVR in IE patients aged 50 to 69 years are different. Methods: All IE patients aged 50 to 69 years with primary MVR in Hubei province hospitals from 2002 to 2018 were retrospectively reviewed. The median duration of follow-up was 8.7 years (IQR, 6.8-10.9 years). Propensity score matching (1:3 ratio) was used to yield 492 patients with comparable baseline features between bioprostheses and mechanical prosthetic valve groups. Outcomes were postoperative mid-to long-term survival, mitral valve reoperation, prosthetic valve endocarditis (PVE), stroke, and major bleeding events. Results: Fifteen-year survival after MVR was 80.6% in the mechanical valve group and 69.3% in the bioprostheses group (HR 0.545, P = .040). The cumulative incidence of mitral valve reoperation was 8.8% with mechanical valves and 21.4% with bioprostheses (HR 0.260, P = .002). The cumulative incidence of PVE was 5.6% with mechanical valves and 7.2% with bioprostheses (HR 0.629, P = .435). The cumulative incidence of stroke was 12.9% with mechanical valves and 10.5% with bioprostheses (HR 1.217, P = .647). The cumulative incidence of major bleeding was 12.0% with mechanical valves and 6.75% with bioprostheses (HR 1.579, P = .268). Conclusions: Mechanical valve prostheses were associated with better survival, lower rates of reoperation compared with bioprostheses within 15 years after MVR in IE patients aged 50 to 69. These findings suggest mechanical valve prostheses may be a more reasonable alternative to bioprostheses in this patient group.

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Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock

Abstract: The presence of sepsis or septic shock as defined in Sepsis-3 definitions is associated with unfavorable outcomes in patients with IE. Surgical treatment has a positive effect on outcomes (in-hospital mortality and 1-year survival) in patients with IE and sepsis or septic shock.

Cited by 30 publications

References 34 publications

Short‐term LPS induces aortic valve thickening in ApoE*3Leiden mice

Short‐term LPS induces aortic valve thickening in ApoE*3Leiden mice

Endocarditis in the Mediterranean Basin

Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years

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