Soléne Patrat-Delon1, Adrien Rouxel2, Arnaud Gacouin1, Matthieu Revest1, Erwan Flécher3, Olivier Fouquet4, Yves Le Tulzo1, Nicolas Lerolle2, Pierre Tattevin1, Jean-Marc Tadié5. 1. Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France. 2. Service de Réanimation Médicale et de Médecine Hyperbare, CHU d'Angers, Angers, France. 3. Département de Chirurgie Thoracique et Cardiovasculaire, CHU de Rennes - Hôpital Pontchaillou, Rennes, France. 4. Département de Chirurgie Thoracique et Cardiovasculaire, CHU d'Angers, Angers, France. 5. Service de Réanimation Médicale et Infectieuse, CHU de Rennes - Hôpital Pontchaillou, Inserm, CIC-1414, Faculté de Médecine, Université Rennes I, Rennes, France jean-marc.tadie@chu-rennes.fr.
Abstract
OBJECTIVES: To better select for patients who most likely will benefit from cardiac surgery among those with infective endocarditis (IE), we aimed to identify preoperative markers associated with poor outcome after cardiac surgery for IE, and to evaluate the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II to predict mortality. METHODS: We enrolled all adult patients who underwent cardiac surgery during the acute phase of definite IE (Duke Criteria) in two referral centres for cardiac surgery. Patients were identified through intensive care unit (ICU) electronic databases, and data were collected from medical charts on standardized questionnaire. RESULTS: Between 2002 and 2013, 149 patients (117 males), with a median age of 64 years [interquartile range 52-73], fulfilled the inclusion criteria. Main complications before surgery were left ventricular dysfunction (23%), central nervous system symptomatic events (34%) and septic shock (24%). Most patients (95%) presented with valve regurgitation, and 49% had perivalvular abscess. Surgery was performed with a median delay of 12 days [5-24] after IE diagnosis, and mean EuroSCORE II was 15.8 (13.4-18.1). In-hospital mortality was 21%. Preoperative variables associated with mortality in multivariate analysis were obesity [odds ratio (OR) 3.67 [1.10-12.19], P = 0.03], vegetation >15 mm (OR 6.72 [1.46-30.98], P = 0.01), septic shock (OR 4.87 [1.67-14.28], P = 0.004) and mechanical prosthetic valve IE (OR 4.99 [1.72-28.57], P = 0.007). EuroSCORE II underestimated mortality in patients with predicted mortality over 10%. CONCLUSION: Factors independently predictive of mortality after cardiac surgery for IE are obesity, septic shock, large vegetation and a mechanical prosthetic valve IE. EuroSCORE II underestimates post-cardiac surgery mortality in patients with IE.
OBJECTIVES: To better select for patients who most likely will benefit from cardiac surgery among those with infective endocarditis (IE), we aimed to identify preoperative markers associated with poor outcome after cardiac surgery for IE, and to evaluate the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II to predict mortality. METHODS: We enrolled all adult patients who underwent cardiac surgery during the acute phase of definite IE (Duke Criteria) in two referral centres for cardiac surgery. Patients were identified through intensive care unit (ICU) electronic databases, and data were collected from medical charts on standardized questionnaire. RESULTS: Between 2002 and 2013, 149 patients (117 males), with a median age of 64 years [interquartile range 52-73], fulfilled the inclusion criteria. Main complications before surgery were left ventricular dysfunction (23%), central nervous system symptomatic events (34%) and septic shock (24%). Most patients (95%) presented with valve regurgitation, and 49% had perivalvular abscess. Surgery was performed with a median delay of 12 days [5-24] after IE diagnosis, and mean EuroSCORE II was 15.8 (13.4-18.1). In-hospital mortality was 21%. Preoperative variables associated with mortality in multivariate analysis were obesity [odds ratio (OR) 3.67 [1.10-12.19], P = 0.03], vegetation >15 mm (OR 6.72 [1.46-30.98], P = 0.01), septic shock (OR 4.87 [1.67-14.28], P = 0.004) and mechanical prosthetic valve IE (OR 4.99 [1.72-28.57], P = 0.007). EuroSCORE II underestimated mortality in patients with predicted mortality over 10%. CONCLUSION: Factors independently predictive of mortality after cardiac surgery for IE are obesity, septic shock, large vegetation and a mechanical prosthetic valve IE. EuroSCORE II underestimates post-cardiac surgery mortality in patients with IE.
Authors: P Fillâtre; A Gacouin; M Revest; A Maamar; S Patrat-Delon; E Flécher; O Fouquet; N Lerolle; J-P Verhoye; Y Le Tulzo; Pierre Tattevin; J-M Tadié Journal: Eur J Clin Microbiol Infect Dis Date: 2019-11-26 Impact factor: 3.267
Authors: Tom E Biersteker; Mark J Boogers; Robert Af de Lind van Wijngaarden; Rolf Hh Groenwold; Serge A Trines; Anouk P van Alem; Charles Jhj Kirchhof; Nicolette van Hof; Robert Jm Klautz; Martin J Schalij; Roderick W Treskes Journal: JMIR Res Protoc Date: 2020-04-21
Authors: Giuseppe Gatti; Andrea Perrotti; Jean-François Obadia; Xavier Duval; Bernard Iung; François Alla; Catherine Chirouze; Christine Selton-Suty; Bruno Hoen; Gianfranco Sinagra; François Delahaye; Pierre Tattevin; Vincent Le Moing; Aniello Pappalardo; Sidney Chocron Journal: J Am Heart Assoc Date: 2017-07-20 Impact factor: 5.501