Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry

Sandro Sponga; Michele Di Mauro; Pietro G. Malvindi; Domenico Paparella; Giacomo Murana; Davide Pacini; Luca Weltert; Ruggero De Paulis; Giangiuseppe Cappabianca; Cesare Beghi; Carlo De Vincentiis; Alessandro Parolari; Antonio Messina; Giovanni Troise; Antonio Salsano; Francesco Santini; Michele D. Pierri; Marco Di Eusanio; Daniele Maselli; Guglielmo Actis Dato; Paolo Centofanti; Samuel Mancuso; Mauro Rinaldi; Giuseppe Cagnoni; Carlo Antona; Marco Piciche; Loris Salvador; Diego Cugola; Lorenzo Galletti; Alberto Pozzoli; Michele De Bonis; Roberto Lorusso; Uberto Bortolotti; Ugolino Livi; Italian Group of Research for Outcome in Cardiac Surgery (GIROC)

doi:10.1093/ejcts/ezaa136

Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry

Sandro Sponga^*, Michele Di Mauro, Pietro G. Malvindi, Domenico Paparella, Giacomo Murana, Davide Pacini, Luca Weltert, Ruggero De Paulis, Giangiuseppe Cappabianca, Cesare Beghi, Carlo De Vincentiis, Alessandro Parolari, Antonio Messina, Giovanni Troise, Antonio Salsano, Francesco Santini, Michele D. Pierri, Marco Di Eusanio, Daniele Maselli, Guglielmo Actis DatoPaolo Centofanti, Samuel Mancuso, Mauro Rinaldi, Giuseppe Cagnoni, Carlo Antona, Marco Piciche, Loris Salvador, Diego Cugola, Lorenzo Galletti, Alberto Pozzoli, Michele De Bonis, Roberto Lorusso, Uberto Bortolotti, Ugolino Livi, Italian Group of Research for Outcome in Cardiac Surgery (GIROC)

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.

METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 +/- 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.

RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 +/- 6% and 71 +/- 7%, with 3 cases of endocarditis relapse.

CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.

[GRAPHICS]

Original language	English
Pages (from-to)	839-846
Number of pages	8
Journal	European Journal of Cardio-Thoracic Surgery
Volume	58
Issue number	4
DOIs	https://doi.org/10.1093/ejcts/ezaa136
Publication status	Published - Oct 2020
Event	33rd European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting - Lisbon, Portugal Duration: 3 Oct 2019 → 5 Oct 2019

Keywords

Endocarditis
Bentall procedure
Aortic valve
Aortic surgery
Aortic root
AORTIC ROOT REPLACEMENT
TERM-FOLLOW-UP
PROSTHETIC VALVE ENDOCARDITIS
INFECTIVE ENDOCARDITIS
SURGICAL-TREATMENT
ASCENDING AORTA
GRAFT
MANAGEMENT

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10.1093/ejcts/ezaa136

Cite this

Sponga, S., Di Mauro, M., Malvindi, P. G., Paparella, D., Murana, G., Pacini, D., Weltert, L., De Paulis, R., Cappabianca, G., Beghi, C., De Vincentiis, C., Parolari, A., Messina, A., Troise, G., Salsano, A., Santini, F., Pierri, M. D., Di Eusanio, M., Maselli, D., ... Italian Group of Research for Outcome in Cardiac Surgery (GIROC) (2020). Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry. European Journal of Cardio-Thoracic Surgery, 58(4), 839-846. https://doi.org/10.1093/ejcts/ezaa136

@article{54243fb056f149bdaec63b5435dc45f0,

title = "Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry",

abstract = "OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 +/- 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 +/- 6% and 71 +/- 7%, with 3 cases of endocarditis relapse.CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.[GRAPHICS]",

keywords = "Endocarditis, Bentall procedure, Aortic valve, Aortic surgery, Aortic root, AORTIC ROOT REPLACEMENT, TERM-FOLLOW-UP, PROSTHETIC VALVE ENDOCARDITIS, INFECTIVE ENDOCARDITIS, SURGICAL-TREATMENT, ASCENDING AORTA, GRAFT, MANAGEMENT",

author = "Sandro Sponga and {Di Mauro}, Michele and Malvindi, {Pietro G.} and Domenico Paparella and Giacomo Murana and Davide Pacini and Luca Weltert and {De Paulis}, Ruggero and Giangiuseppe Cappabianca and Cesare Beghi and {De Vincentiis}, Carlo and Alessandro Parolari and Antonio Messina and Giovanni Troise and Antonio Salsano and Francesco Santini and Pierri, {Michele D.} and {Di Eusanio}, Marco and Daniele Maselli and Dato, {Guglielmo Actis} and Paolo Centofanti and Samuel Mancuso and Mauro Rinaldi and Giuseppe Cagnoni and Carlo Antona and Marco Piciche and Loris Salvador and Diego Cugola and Lorenzo Galletti and Alberto Pozzoli and {De Bonis}, Michele and Roberto Lorusso and Uberto Bortolotti and Ugolino Livi and {Italian Group of Research for Outcome in Cardiac Surgery (GIROC)}",

year = "2020",

month = oct,

doi = "10.1093/ejcts/ezaa136",

language = "English",

volume = "58",

pages = "839--846",

journal = "European Journal of Cardio-Thoracic Surgery",

issn = "1010-7940",

publisher = "Oxford University Press",

number = "4",

note = "33rd European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting ; Conference date: 03-10-2019 Through 05-10-2019",

}

Sponga, S, Di Mauro, M, Malvindi, PG, Paparella, D, Murana, G, Pacini, D, Weltert, L, De Paulis, R, Cappabianca, G, Beghi, C, De Vincentiis, C, Parolari, A, Messina, A, Troise, G, Salsano, A, Santini, F, Pierri, MD, Di Eusanio, M, Maselli, D, Dato, GA, Centofanti, P, Mancuso, S, Rinaldi, M, Cagnoni, G, Antona, C, Piciche, M, Salvador, L, Cugola, D, Galletti, L, Pozzoli, A, De Bonis, M, Lorusso, R, Bortolotti, U, Livi, U & Italian Group of Research for Outcome in Cardiac Surgery (GIROC) 2020, 'Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry', European Journal of Cardio-Thoracic Surgery, vol. 58, no. 4, pp. 839-846. https://doi.org/10.1093/ejcts/ezaa136

TY - JOUR

T1 - Surgery for Bentall endocarditis

T2 - 33rd European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting

AU - Sponga, Sandro

AU - Di Mauro, Michele

AU - Malvindi, Pietro G.

AU - Paparella, Domenico

AU - Murana, Giacomo

AU - Pacini, Davide

AU - Weltert, Luca

AU - De Paulis, Ruggero

AU - Cappabianca, Giangiuseppe

AU - Beghi, Cesare

AU - De Vincentiis, Carlo

AU - Parolari, Alessandro

AU - Messina, Antonio

AU - Troise, Giovanni

AU - Salsano, Antonio

AU - Santini, Francesco

AU - Pierri, Michele D.

AU - Di Eusanio, Marco

AU - Maselli, Daniele

AU - Dato, Guglielmo Actis

AU - Centofanti, Paolo

AU - Mancuso, Samuel

AU - Rinaldi, Mauro

AU - Cagnoni, Giuseppe

AU - Antona, Carlo

AU - Piciche, Marco

AU - Salvador, Loris

AU - Cugola, Diego

AU - Galletti, Lorenzo

AU - Pozzoli, Alberto

AU - De Bonis, Michele

AU - Lorusso, Roberto

AU - Bortolotti, Uberto

AU - Livi, Ugolino

AU - Italian Group of Research for Outcome in Cardiac Surgery (GIROC)

PY - 2020/10

Y1 - 2020/10

N2 - OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 +/- 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 +/- 6% and 71 +/- 7%, with 3 cases of endocarditis relapse.CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.[GRAPHICS]

AB - OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 +/- 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 +/- 6% and 71 +/- 7%, with 3 cases of endocarditis relapse.CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.[GRAPHICS]

KW - Endocarditis

KW - Bentall procedure

KW - Aortic valve

KW - Aortic surgery

KW - Aortic root

KW - AORTIC ROOT REPLACEMENT

KW - TERM-FOLLOW-UP

KW - PROSTHETIC VALVE ENDOCARDITIS

KW - INFECTIVE ENDOCARDITIS

KW - SURGICAL-TREATMENT

KW - ASCENDING AORTA

KW - GRAFT

KW - MANAGEMENT

U2 - 10.1093/ejcts/ezaa136

DO - 10.1093/ejcts/ezaa136

M3 - Article

C2 - 32417897

SN - 1010-7940

VL - 58

SP - 839

EP - 846

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

IS - 4

Y2 - 3 October 2019 through 5 October 2019

ER -