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

Jakuška, Povilas; Ereminienė, Eglė; Muliuolyte, Egle; Kosys, Vidas; Pavlavičius, Lukas; Žukovas, Giedrius; Karčiauskas, Dainius; Benetis, Rimantas

doi:10.1177/0267659119872345

Cited by 9 publications

(9 citation statements)

References 18 publications

(23 reference statements)

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“…Postoperative sepsis and subsequent organ failure is an important cause of mortality in patients undergoing cardiac surgery for infective endocarditis [1,2]. Systemic inflammatory response in combination with systemic infection resulting in severe sepsis is orchestrated with the cytokines as messengers [3][4][5][6][7][8][9][10][11][12]. We previously reported that intraoperative hemoadsorption reduced the incidence of postoperative sepsis and sepsis-related death in patients with infective endocarditis of the native mitral valve undergoing surgical therapy [13].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative hemoadsorption in high-risk patients with infective endocarditis

et al. 2022

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Background Postoperative sepsis is an important cause of morbidity and mortality in patients with infective endocarditis undergoing surgical therapy. Blood purification using hemoadsorption therapy shows promising results in the treatment of sepsis. In this study, the clinical effects of intraoperative hemoadsorption in high-risk patients with infective endocarditis were evaluated. Methods Eligible candidates were high-risk patients with infective endocarditis undergoing cardiac surgery between January 2014 and December 2019. Patients with intraoperative hemoadsorption (hemoadsorption) were compared to patients without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Additionally, postoperative vasopressor need, systemic vascular resistance indices and Sequential Organ Failure Assessment (SOFA) scores were compared. Results After propensity score matching, 70 high-risk patients were included. Postoperative sepsis occurred in 14 patients in the hemoadsorption group and in 16 patients in the control group, p = 0.629. Four patients died due to postoperative sepsis in the hemoadsorption group, while 11 postoperative septic patients died in the control group, p = 0.041. In-hospital mortality was 34% in the hemoadsorption group versus 43% in the control group, p = 0.461. On ICU-admission and the first postoperative day, the cumulative vasopressor need was 0.17 versus 0.25 μg/kgBW/min, p = 0.123 and 0.06 versus 0.11 μg/kgBW/min, p = 0.037, and the systemic vascular resistance index was 1448 versus 941 dyn·s·cm-5, p = 0.013 and 1156 versus 858 dyn·s·cm-5, p = 0.110 in the hemoadsorption versus control group, respectively. Postoperative course of SOFA score normalized significantly (p = 0.01) faster in the hemoadsorption group. Conclusions In high-risk cardiac surgical patients with infective endocarditis, intraoperative hemoadsorption significantly reduced sepsis-associated mortality. Furthermore, intraoperative hemoadsorption resulted in significant faster recovery of hemodynamics and organ function. Intraoperative hemoadsorption seems to attenuate the severity of postoperative sepsis.

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Section: Introductionmentioning

confidence: 99%

Intraoperative hemoadsorption in high-risk patients with infective endocarditis

et al. 2022

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“…Invasive procedures used to treat cardiovascular conditions such as endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially when patients present with several pre-existing comorbidities. [5][6][7][8] In this series of patients that underwent the AngioVac procedure as a minimally invasive alternative, a total of 28 (85%) of procedures were deemed successful. Our institutional success rate is comparable to a rate of 70% from another institution study of 20 patients while a recently reported meta-analysis of 301 patients and 44 studies had a procedural success rates up to 89.2% using similar definitions of success.…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses

Nickell

Sergev

Alberto

et al. 2023

Cathet Cardio Intervent

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Background: Invasive procedures used to manage intravascular masses such as vegetation from endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially in patients with several pre-existing comorbidities. A minimally invasive technique that has become more popular in recent years is the AngioVac procedure. This singlecentered, retrospective study focuses on patient presenting comorbidities and indications for the procedure as well as postprocedural outcomes.Methods: A total of 33 patients who underwent an AngioVac procedure at Sanford Health between March 2014 and October 2019 was reviewed. Data were collected on pre-existing comorbidities, indication of procedure, length of stay, and postoperative outcomes.Results: We evaluated a total of 33 patients who underwent an AngioVac procedure for removal of intravascular mass. The most common indications for the procedure were endocarditis (24/33, 73%); intracardiac mass (5/33, 15%); and deep vein thrombosis or pulmonary embolism (2/33, 6%). Post-procedural blood transfusion was required in nearly half (15/33, 45%). Almost all patients (31/33, 94%) required intraoperative vasopressor use. Nearly all patients (32/33, 97%) were directed to the intensive care unit following the procedure with an average length of stay of 8 days (interquartile range: 3−13). Most common complications seen after the procedure were shock requiring vasopressors, (13/33, 39%), pleural effusion (9/33, 27%), and sepsis (4/33, 12%). Procedural success in this single-centered experience was 85% (28/33), which was defined as size reduction of the initial vegetation by >50% in the absence of severe intraoperative complications and absence of need for further valvular surgical intervention. Conclusion:For surgically high-risk patients, the AngioVac procedure may offer a less invasive option in the management of right sided endocarditis requiring vegetation debulking, intravascular thrombi or cardiac masses.

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“… 30 Furthermore, age is used in most cardiac surgery risk score systems. 13 , 15 , 25 , 31 , 32 However, overall patients with IE are younger than most patients requiring cardiac surgery. 33 , 34 In our development cohort, although the mean age of survivors was slightly less than that of nonsurvivors (43.36±15.119 versus 48.05±17.509 years), there was no significant difference ( P =0.1877) between the 2 groups (Figure S6 ).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with perivalvular complications in our cohorts did not have a higher risk, although perivalvular complications were once considered to be a high‐risk factor. 31 Thus, it was also not included in SYSUPMIE. In fact, whether perivalvular abscesses increase the perioperative mortality rate is inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning–Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis

Luo

Huang

Liu

et al. 2022

JAHA

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Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy‐to‐use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670–0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606–0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P <0.01). This model was used to develop an online, open‐access calculator ( http://42.240.140.58:1808/ ). Conclusions We constructed and validated an accurate and robust machine learning–based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision‐making and improve outcomes.

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

Cited by 9 publications

References 18 publications

Intraoperative hemoadsorption in high-risk patients with infective endocarditis

Intraoperative hemoadsorption in high-risk patients with infective endocarditis

Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses

Machine Learning–Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis

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