Hwee-Leong Tan1, Louis Y A Chai1, Tiong-Cheng Yeo2, Boon-Lock Chia2, Paul A Tambyah1, Kian-Keong Poh3. 1. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Center, National University Health System, Singapore. 3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Center, National University Health System, Singapore. Electronic address: kian_keong_poh@nuhs.edu.sg.
Abstract
BACKGROUND: We aimed to study patients with prosthetic valve endocarditis (PVE) and analyse factors associated with in-hospital adverse events. METHODS: A review of all patients who underwent echocardiography at a local university hospital with definite PVE (modified Duke's criteria) was performed. Adverse events of in-hospital mortality and redo valve surgery were identified. RESULTS: There were 23 patients with PVE (median age 53 years (IQR:38-66), 12 males (52%)). Twelve adverse events occurred including seven (30%) in-hospital mortalities and five (21%) redo valve surgery. Factors associated with in-hospital mortality include Staphylococcus aureus-PVE (86% vs 31%, p=0.027), presence of shock (86% vs 19%, p=0.005) and intensive care unit admission (72% vs 19%, p=0.026). Factors associated with the need for redo valve surgery include a younger median age (37 vs 61 years, p=0.012), longer median length of stay (58 vs 17 days, p=0.004), history of intravenous drug abuse (IVDA) (60% vs 6%, p=0.021) and right-sided valvular involvement (40% vs 0%, p=0.040). Using a composite endpoint of both outcomes, factors associated with in-hospital adverse events were a history of IVDA (36% vs 0%, p=0.037) and presence of shock (64% vs 17%, p=0.036). CONCLUSION: PVE carries a high risk of poor clinical outcome in terms of in-hospital mortality and the need for redo surgery.
BACKGROUND: We aimed to study patients with prosthetic valve endocarditis (PVE) and analyse factors associated with in-hospital adverse events. METHODS: A review of all patients who underwent echocardiography at a local university hospital with definite PVE (modified Duke's criteria) was performed. Adverse events of in-hospital mortality and redo valve surgery were identified. RESULTS: There were 23 patients with PVE (median age 53 years (IQR:38-66), 12 males (52%)). Twelve adverse events occurred including seven (30%) in-hospital mortalities and five (21%) redo valve surgery. Factors associated with in-hospital mortality include Staphylococcus aureus-PVE (86% vs 31%, p=0.027), presence of shock (86% vs 19%, p=0.005) and intensive care unit admission (72% vs 19%, p=0.026). Factors associated with the need for redo valve surgery include a younger median age (37 vs 61 years, p=0.012), longer median length of stay (58 vs 17 days, p=0.004), history of intravenous drug abuse (IVDA) (60% vs 6%, p=0.021) and right-sided valvular involvement (40% vs 0%, p=0.040). Using a composite endpoint of both outcomes, factors associated with in-hospital adverse events were a history of IVDA (36% vs 0%, p=0.037) and presence of shock (64% vs 17%, p=0.036). CONCLUSION: PVE carries a high risk of poor clinical outcome in terms of in-hospital mortality and the need for redo surgery.