Prosthetic valve endocarditis: Predictors of early outcome of surgical therapy. A multicentric study

Nicola Luciani, Franco Glieca, Giovanni Alfonso Chiariello, Mario Tumbarello, Eugenio Mossuto, Davide Ricci, Marco Russo, Antonio Salsano, Alberto Pozzoli, Michele D. Pierri, Augusto D'Onofrio, Alberto Canziani, Mauro Rinaldi, Paolo Nardi, Francesco Santini, Michele De Bonis, Lucia Torracca, Eleonora Bizzotto

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

9 Citazioni (Scopus)

Abstract

OBJECTIVES: Prosthetic valve endocarditis (PVE) is an uncommon yet dreadful complication in patients with prosthetic valves that requires a distinct analysis from native valve endocarditis. The present study aims to investigate independent risk factors for early surgical outcomes in patients with PVE. METHODS: A retrospective cohort study was conducted in 8 Italian Cardiac Surgery Units from January 2000 to December 2013 by enrolling all PVE patients undergoing surgical treatment. RESULTS: A total of 209 consecutive patients were included in the study. During the study period, the global rate of surgical procedures for PVE among all operations for isolated or associated valvular disease was 0.45%. Despite its rarity this percentage increased significantly during the second time frame (2007-2013) in comparison with the previous one (2000-2006): 0.58% vs 0.31% (P < 0.001). Intraoperative and in-hospital mortality rates were 4.3% and 21.5%, respectively. Logistic regression analysis identified the following factors associated with in-hospital mortality: female gender [odds ratio (OR) = 4.62; P < 0.001], shock status (OR = 3.29; P = 0.02), previous surgical procedures within 3 months from the treatment (OR = 3.57; P = 0.009), multivalvular involvement (OR = 8.04; P = 0.003), abscess (OR = 2.48; P = 0.03) and urgent surgery (OR = 6.63; P < 0.001). CONCLUSIONS: Despite its rarity, PVE showed a significant increase over time. Up to now, in-hospital mortality after surgical treatment still remains high ( > 20%). Critical clinical presentation and extension of anatomical lesions are strong preoperative predictors for poor early outcome.
Lingua originaleEnglish
pagine (da-a)768-774
Numero di pagine7
RivistaEuropean Journal of Cardio-thoracic Surgery
Volume52
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Adult
  • Aged
  • Cardiology and Cardiovascular Medicine
  • Cohort Studies
  • Endocarditis
  • Female
  • Follow-Up Studies
  • Heart Valve Diseases
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation
  • Hospital Mortality
  • Humans
  • Infection
  • Italy
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prosthesis
  • Prosthesis-Related Infections
  • Pulmonary and Respiratory Medicine
  • Redo-surgery
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Staphylococcal Infections
  • Surgery
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Valves

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