Simon Rouzé1, Erwan Flécher2, Matthieu Revest3, Amedeo Anselmi2, Marie Aymami2, Antoine Roisné4, Julien Guihaire2, Jean Philippe Verhoye2. 1. Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France. Electronic address: simon.rouze@chu-rennes.fr. 2. Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France. 3. Department of Infectious Diseases, Rennes University Health Centre, Rennes, France. 4. Department of Anaesthesiology and Intensive Care, Rennes University Health Centre, Rennes, France.
Abstract
BACKGROUND: We investigated our surgical strategy and clinical results in patients from active infective endocarditis (AIE) complicated by paravalvular involvement to determine the risk factors of early and late death and reoperation. METHODS: From October 1979 to December 2014, 955 patients underwent operations for AIE; among them 207 had AIE with paravalvular extension. The patients were a mean age of 59.9 ± 15.4 years, and 162 (78%) were male. Of these patients, 137 (66%) had isolated aortic valve endocarditis, and 138 (67%) had native valve endocarditis. Follow-up was 99% complete. RESULTS: The operative mortality of the cohort was 16% (n = 34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day death. Survival at 1, 5, 10, and 15 years was 90.3% ± 2.3%, 62.4% ± 3.7%, 49.3% ± 4.1%, and 37.9% ± 4.4%, respectively. Streptococcus endocarditis (all species), complex annular repair, and preoperative heart failure were independent predictors of long-term death. A reoperation was required in 29 patients (14%). Streptococcus pneumoniae endocarditis was the only independent predictor of early reoperation (within 30 days after the operation or during the same hospitalization). Freedom from reoperation at 1, 5, 10, and 15 years was 91.9% ± 2.2%, 89.6% ± 2.6%, 89.6% ± 2.6%, and 87.0% ± 3.5%, respectively. Independent predictors of late reoperation were urgent/emergency operation, prosthetic valve endocarditis, and complex annular repair. CONCLUSIONS: AIE complicated by paravalvular involvement remains a surgical challenge. Valve replacement (particularly using bioprosthesis) associated with ad hoc reconstruction seems to be a reliable option and showed very encouraging results in this context.
BACKGROUND: We investigated our surgical strategy and clinical results in patients from active infective endocarditis (AIE) complicated by paravalvular involvement to determine the risk factors of early and late death and reoperation. METHODS: From October 1979 to December 2014, 955 patients underwent operations for AIE; among them 207 had AIE with paravalvular extension. The patients were a mean age of 59.9 ± 15.4 years, and 162 (78%) were male. Of these patients, 137 (66%) had isolated aortic valve endocarditis, and 138 (67%) had native valve endocarditis. Follow-up was 99% complete. RESULTS: The operative mortality of the cohort was 16% (n = 34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day death. Survival at 1, 5, 10, and 15 years was 90.3% ± 2.3%, 62.4% ± 3.7%, 49.3% ± 4.1%, and 37.9% ± 4.4%, respectively. Streptococcus endocarditis (all species), complex annular repair, and preoperative heart failure were independent predictors of long-term death. A reoperation was required in 29 patients (14%). Streptococcus pneumoniae endocarditis was the only independent predictor of early reoperation (within 30 days after the operation or during the same hospitalization). Freedom from reoperation at 1, 5, 10, and 15 years was 91.9% ± 2.2%, 89.6% ± 2.6%, 89.6% ± 2.6%, and 87.0% ± 3.5%, respectively. Independent predictors of late reoperation were urgent/emergency operation, prosthetic valve endocarditis, and complex annular repair. CONCLUSIONS: AIE complicated by paravalvular involvement remains a surgical challenge. Valve replacement (particularly using bioprosthesis) associated with ad hoc reconstruction seems to be a reliable option and showed very encouraging results in this context.
Authors: Sami Kueri; Fabian A Kari; Rafael Ayala Fuentes; Hans-Hinrich Sievers; Friedhelm Beyersdorf; Wolfgang Bothe Journal: Dtsch Arztebl Int Date: 2019-06-21 Impact factor: 5.594
Authors: Andreas Schaefer; Jannis Dickow; Gerhard Schoen; Sumi Westhofen; Lisa Kloss; Tarik Al-Saydali; Hermann Reichenspurner; Sebastian A Philipp; Christian Detter Journal: PLoS One Date: 2018-01-16 Impact factor: 3.240