Matheus de Oliveira Andrade1, Gabriel Elias Salmen Raffoul1, Murilo Teixeira Macedo2, Claudia Neto Gonçalves Neves da Silva3, Maria Aparecida Santos Teixeira4, Sônia Jaciara Neto Pontes5, Mauricio Daher6, Claudio Ribeiro da Cunha7, Fernando Antibas Atik8. 1. Undergraduate Student, Universidade de Brasília (UnB), Brasília (DF), Brazil. 2. MD. Cardiovascular Surgeon, Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 3. MD, MSc. Infectiologist, Department of Infection Control, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 4. MD. Infectiologist, Department of Infection Control, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 5. Nurse, Department of Infection Control, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 6. MD, PhD. Anesthetist, Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 7. MD, PhD. Cardiovascular Surgeon, Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil. 8. MD, PhD. Cardiovascular Surgeon and Head of the Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal (ICDF), Brasília (DF), Brazil.
Abstract
BACKGROUND: The aim of this study was to describe the experience of treatment of early prosthetic valve endocarditis at a heart center. DESIGN AND SETTING: Retrospective single-center study on data collected from electronic medical records covering the period from January 2009 to December 2015. METHODS: Over the study period, 1,557 consecutive valve operations were performed on adult patients. The study population comprised 32 patients (2%) who were diagnosed with prosthetic valve endocarditis within 12 months after the index surgery. Medical records were retrieved from electronic hospital records, retrospectively. Descriptive clinical, echocardiographic, microbiological and treatment-type data were used. Risk factors for early mortality were studied through univariate and multivariate analyses. RESULTS: The main clinical manifestation of infective endocarditis was fever, and this was present in all patients. Most of the prostheses were affected in the aortic position (40.6% of cases). The most commonly cultured microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. Twenty-six patients (81.3%) underwent surgical treatment and six (18.7%) underwent exclusive clinical treatment. The prevalence of postoperative complications was 31.3% and hospital mortality occurred in seven cases (21.9%). The mortality rate was 50% among the patients who underwent medical treatment and 15.4% among those who underwent surgery. There were no independent risk factors for mortality. CONCLUSION: Prosthetic valve endocarditis is an infrequent complication of valve replacement. Surgical treatment has mortality rates compatible with the severity of patients' conditions. Surgical indication should not be delayed when clinical treatment has been ineffective.
BACKGROUND: The aim of this study was to describe the experience of treatment of early prosthetic valve endocarditis at a heart center. DESIGN AND SETTING: Retrospective single-center study on data collected from electronic medical records covering the period from January 2009 to December 2015. METHODS: Over the study period, 1,557 consecutive valve operations were performed on adult patients. The study population comprised 32 patients (2%) who were diagnosed with prosthetic valve endocarditis within 12 months after the index surgery. Medical records were retrieved from electronic hospital records, retrospectively. Descriptive clinical, echocardiographic, microbiological and treatment-type data were used. Risk factors for early mortality were studied through univariate and multivariate analyses. RESULTS: The main clinical manifestation of infective endocarditis was fever, and this was present in all patients. Most of the prostheses were affected in the aortic position (40.6% of cases). The most commonly cultured microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. Twenty-six patients (81.3%) underwent surgical treatment and six (18.7%) underwent exclusive clinical treatment. The prevalence of postoperative complications was 31.3% and hospital mortality occurred in seven cases (21.9%). The mortality rate was 50% among the patients who underwent medical treatment and 15.4% among those who underwent surgery. There were no independent risk factors for mortality. CONCLUSION: Prosthetic valve endocarditis is an infrequent complication of valve replacement. Surgical treatment has mortality rates compatible with the severity of patients' conditions. Surgical indication should not be delayed when clinical treatment has been ineffective.
Authors: Sophia L Alexis; Aaqib H Malik; Isaac George; Rebecca T Hahn; Omar K Khalique; Karthik Seetharam; Deepak L Bhatt; Gilbert H L Tang Journal: J Am Heart Assoc Date: 2020-08-08 Impact factor: 5.501