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

Nicola Luciani, Eugenio Mossuto, Davide Ricci, Marco Luciani, Marco Russo, Antonio Salsano, Alberto Pozzoli, Michele D. Pierri, Augusto D'Onofrio, Giovanni A. Chiariello, Franco Glieca, Alberto Canziani, Mauro Rinaldi, Paolo Nardi, Valentina Milazzo, Enrico M. Trecarichi, Francesco Santini, Michele De Bonis, Lucia Torracca, Eleonora BizzottoMario Tumbarello

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)768-774
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number4
DOIs
Publication statusPublished - Oct 1 2017

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Endocarditis
Therapeutics
Thoracic Surgery
Cohort Studies
Retrospective Studies

Keywords

  • Endocarditis
  • Infection
  • Prosthesis
  • Redo-surgery
  • Valves

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Luciani, N., Mossuto, E., Ricci, D., Luciani, M., Russo, M., Salsano, A., ... Tumbarello, M. (2017). Prosthetic valve endocarditis: Predictors of early outcome of surgical therapy. A multicentric study. European Journal of Cardio-thoracic Surgery, 52(4), 768-774. https://doi.org/10.1093/ejcts/ezx169

Prosthetic valve endocarditis : Predictors of early outcome of surgical therapy. A multicentric study. / Luciani, Nicola; Mossuto, Eugenio; Ricci, Davide; Luciani, Marco; Russo, Marco; Salsano, Antonio; Pozzoli, Alberto; Pierri, Michele D.; D'Onofrio, Augusto; Chiariello, Giovanni A.; Glieca, Franco; Canziani, Alberto; Rinaldi, Mauro; Nardi, Paolo; Milazzo, Valentina; Trecarichi, Enrico M.; Santini, Francesco; Bonis, Michele De; Torracca, Lucia; Bizzotto, Eleonora; Tumbarello, Mario.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 4, 01.10.2017, p. 768-774.

Research output: Contribution to journalArticle

Luciani, N, Mossuto, E, Ricci, D, Luciani, M, Russo, M, Salsano, A, Pozzoli, A, Pierri, MD, D'Onofrio, A, Chiariello, GA, Glieca, F, Canziani, A, Rinaldi, M, Nardi, P, Milazzo, V, Trecarichi, EM, Santini, F, Bonis, MD, Torracca, L, Bizzotto, E & Tumbarello, M 2017, 'Prosthetic valve endocarditis: Predictors of early outcome of surgical therapy. A multicentric study', European Journal of Cardio-thoracic Surgery, vol. 52, no. 4, pp. 768-774. https://doi.org/10.1093/ejcts/ezx169
Luciani, Nicola ; Mossuto, Eugenio ; Ricci, Davide ; Luciani, Marco ; Russo, Marco ; Salsano, Antonio ; Pozzoli, Alberto ; Pierri, Michele D. ; D'Onofrio, Augusto ; Chiariello, Giovanni A. ; Glieca, Franco ; Canziani, Alberto ; Rinaldi, Mauro ; Nardi, Paolo ; Milazzo, Valentina ; Trecarichi, Enrico M. ; Santini, Francesco ; Bonis, Michele De ; Torracca, Lucia ; Bizzotto, Eleonora ; Tumbarello, Mario. / Prosthetic valve endocarditis : Predictors of early outcome of surgical therapy. A multicentric study. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 52, No. 4. pp. 768-774.
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T2 - Predictors of early outcome of surgical therapy. A multicentric study

AU - Luciani, Nicola

AU - Mossuto, Eugenio

AU - Ricci, Davide

AU - Luciani, Marco

AU - Russo, Marco

AU - Salsano, Antonio

AU - Pozzoli, Alberto

AU - Pierri, Michele D.

AU - D'Onofrio, Augusto

AU - Chiariello, Giovanni A.

AU - Glieca, Franco

AU - Canziani, Alberto

AU - Rinaldi, Mauro

AU - Nardi, Paolo

AU - Milazzo, Valentina

AU - Trecarichi, Enrico M.

AU - Santini, Francesco

AU - Bonis, Michele De

AU - Torracca, Lucia

AU - Bizzotto, Eleonora

AU - Tumbarello, Mario

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N2 - 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.

AB - 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.

KW - Endocarditis

KW - Infection

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KW - Redo-surgery

KW - Valves

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