Shekhar Saha1,2, Dominik Joskowiak1,2, Mateo Marin-Cuartas3, Mahmoud Diab4, Benedikt M Schwaiger5, Rodrigo Sandoval-Boburg6, Aron-Frederik Popov6, Carolyn Weber7, Sam Varghese8, Andreas Martens9, Serghei Cebotari9, Maximilian Scherner8, Walter Eichinger5, David Holzhey3, Daniel-Sebastian Dohle10, Thorsten Wahlers7, Torsten Doenst4, Martin Misfeld3,11,12,13,14, Julinda Mehilli15,16, Steffen Massberg15, Christian Hagl1,2. 1. Department of Cardiac Surgery, LMU University Hospital, Munich, Germany. 2. German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany. 3. University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 4. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany. 5. Department of Cardiac Surgery, Munich Municipal Hospital Bogenhausen, Technical University of Munich, Munich, Germany. 6. Department of Thoracic and Cardiovascular Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany. 7. Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. 8. Department of Cardiothoracic Surgery, Otto-von-Guericke University, Magdeburg, Germany. 9. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. 10. Department of Cardiovascular Surgery, University Hospital Mainz, Mainz, Germany. 11. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 12. Institute of Academic Surgery, RPAH, Sydney, NSW, Australia. 13. The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia. 14. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 15. Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany. 16. Department of Cardiology, Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany.
Abstract
OBJECTIVES: With the expansion of transcatheter aortic valve replacement (TAVR) into intermediate and low risk, the number of TAVR procedures is bound to rise and along with it the number of cases of infective endocarditis following TAVR (TIE). The aim of this study was to review a multicentre experience of patients undergoing surgical intervention for TIE and to analyse the underlying indications and operative results. METHODS: We retrospectively identified and analysed 69 patients who underwent cardiac surgery due to TIE at 9 cardiac surgical departments across Germany. The primary outcome was operative mortality, 6-month and 1-year survival. RESULTS: Median age was 78 years (72-81) and 48(69.6%) were male. The median time to surgical aortic valve replacement was 14 months (5-24) after TAVR, with 32 patients (46.4%) being diagnosed with early TIE. Cardiac reoperations were performed in 17% of patients and 33% underwent concomitant mitral valve surgery. The main causative organisms were: Enterococcus faecalis (31.9%), coagulase-negative Staphylococcus spp. (26.1%), Methicillin-sensitive Staphylococcus aureus (15.9%) and viridians group streptococci (14.5%). Extracorporeal life support was required in 2 patients (2.9%) for a median duration of 3 days. Postoperative adverse cerebrovascular events were observed in 13 patients (18.9%). Postoperatively, 9 patients (13.0%) required a pacemaker and 33 patients (47.8%) needed temporary renal replacement therapy. Survival to discharge was 88.4% and survival at 6 months and 1 year was found to be 68% and 53%, respectively. CONCLUSIONS: Our results suggest that TIE can be treated according to the guidelines for prosthetic valve endocarditis, namely with early surgery. Surgery for TIE is associated with acceptable morbidity and mortality rates. Surgery should be discussed liberally as a treatment option in patients with TIE by the 'endocarditis team' in referral centres.
OBJECTIVES: With the expansion of transcatheter aortic valve replacement (TAVR) into intermediate and low risk, the number of TAVR procedures is bound to rise and along with it the number of cases of infective endocarditis following TAVR (TIE). The aim of this study was to review a multicentre experience of patients undergoing surgical intervention for TIE and to analyse the underlying indications and operative results. METHODS: We retrospectively identified and analysed 69 patients who underwent cardiac surgery due to TIE at 9 cardiac surgical departments across Germany. The primary outcome was operative mortality, 6-month and 1-year survival. RESULTS: Median age was 78 years (72-81) and 48(69.6%) were male. The median time to surgical aortic valve replacement was 14 months (5-24) after TAVR, with 32 patients (46.4%) being diagnosed with early TIE. Cardiac reoperations were performed in 17% of patients and 33% underwent concomitant mitral valve surgery. The main causative organisms were: Enterococcus faecalis (31.9%), coagulase-negative Staphylococcus spp. (26.1%), Methicillin-sensitive Staphylococcus aureus (15.9%) and viridians group streptococci (14.5%). Extracorporeal life support was required in 2 patients (2.9%) for a median duration of 3 days. Postoperative adverse cerebrovascular events were observed in 13 patients (18.9%). Postoperatively, 9 patients (13.0%) required a pacemaker and 33 patients (47.8%) needed temporary renal replacement therapy. Survival to discharge was 88.4% and survival at 6 months and 1 year was found to be 68% and 53%, respectively. CONCLUSIONS: Our results suggest that TIE can be treated according to the guidelines for prosthetic valve endocarditis, namely with early surgery. Surgery for TIE is associated with acceptable morbidity and mortality rates. Surgery should be discussed liberally as a treatment option in patients with TIE by the 'endocarditis team' in referral centres.
Authors: Shekhar Saha; Ahmad Ali; Philipp Schnackenburg; Konstanze Maria Horke; Andreas Oberbach; Nadine Schlichting; Sebastian Sadoni; Konstantinos Rizas; Daniel Braun; Maximilian Luehr; Erik Bagaev; Christian Hagl; Dominik Joskowiak Journal: J Clin Med Date: 2022-06-14 Impact factor: 4.964