Surgery for prosthetic valve endocarditis: a retrospective study of a national registry

Alessandro Della Corte, Michele Di Mauro, Guglielmo Actis Dato, Fabio Barili, Diego Cugola, Sandro Gelsomino, Pasquale Santè, Antonio Carozza, Ester Della Ratta, Lorenzo Galletti, Roger Devotini, Riccardo Casabona, Francesco Santini, Antonio Salsano, Roberto Scrofani, Carlo Antona, Carlo De Vincentiis, Andrea Biondi, Cesare Beghi, Giangiuseppe CappabiancaMichele De Bonis, Alberto Pozzoli, Francesco Nicolini, Filippo Benassi, Davide Pacini, Roberto Di Bartolomeo, Andrea De Martino, Uberto Bortolotti, Roberto Lorusso, Enrico Vizzardi, Gabriele Di Giammarco, Daniele Marinelli, Emmanuel Villa, Giovanni Troise, Domenico Paparella, Vito Margari, Francesco Tritto, Girolamo Damiani, Giuseppe Scrascia, Salvatore Zaccaria, Attilio Renzulli, Giuseppe Serraino, Giovanni Mariscalco, Daniele Maselli, Alessandro Parolari, Giannantonio Nappi

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Abstract

OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.

METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.

RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P  = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P  < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P  < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P  = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P  = 0.03), renal insufficiency (OR = 2.1; P  = 0.05), triple valve surgery (OR = 6.9; P  = 0.004) and shock (OR = 4.5; P  < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P  < 0.001), Enterococcus (OR = 2.3; P  = 0.01) and female sex (OR = 1.5; P  = 0.03) independently predicted complications, whereas ejection fraction was protective.

CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.

Original languageEnglish
Pages (from-to)105-111
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number1
DOIs
Publication statusPublished - Jul 1 2017

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Della Corte, A., Di Mauro, M., Actis Dato, G., Barili, F., Cugola, D., Gelsomino, S., Santè, P., Carozza, A., Della Ratta, E., Galletti, L., Devotini, R., Casabona, R., Santini, F., Salsano, A., Scrofani, R., Antona, C., De Vincentiis, C., Biondi, A., Beghi, C., ... Nappi, G. (2017). Surgery for prosthetic valve endocarditis: a retrospective study of a national registry. European Journal of Cardio-thoracic Surgery, 52(1), 105-111. https://doi.org/10.1093/ejcts/ezx045