Surgery for prosthetic valve endocarditis: a retrospective study of a national registry

Alessandro Della Corte; Michele Di Mauro; Guglielmo Actis Dato; Fabio Barili; Diego Cugola; Sandro Gelsomino; Pasquale Sante; Antonio Carozza; Ester Della Ratta; Lorenzo Galletti; Roger Devotini; Riccardo Casabona; Francesco Santini; Antonio Salsano; Roberto Scrofani; Carlo Antona; Carlo De Vincentiis; Andrea Biondi; Cesare Beghi; Giangiuseppe Cappabianca; Michele De Bonis; Alberto Pozzoli; Francesco Nicolini; Filippo Benassi; Davide Pacini; Roberto Di Bartolomeo; Andrea De Martino; Uberto Bortolotti; Roberto Lorusso; Enrico Vizzardi; Gabriele Di Giammarco; Daniele Marinelli; Emmanuel Villa; Giovanni Troise; Domenico Paparella; Vito Margari; Francesco Tritto; Girolamo Damiani; Giuseppe Scrascia; Salvatore Zaccaria; Attilio Renzulli; Giuseppe Serraino; Giovanni Mariscalco; Daniele Maselli; Alessandro Parolari; Giannantonio Nappi

doi:10.1093/ejcts/ezx045

Surgery for prosthetic valve endocarditis: a retrospective study of a national registry

Alessandro Della Corte^*
, Michele Di Mauro
, Guglielmo Actis Dato
, Fabio Barili
, Diego Cugola
, Sandro Gelsomino
, Pasquale Sante
, Antonio Carozza
, Ester Della Ratta
, Lorenzo Galletti
, Roger Devotini
, Riccardo Casabona
, Francesco Santini
, Antonio Salsano
, Roberto Scrofani
, Carlo Antona
, Carlo De Vincentiis
, Andrea Biondi
, Cesare Beghi
, Giangiuseppe Cappabianca

Michele De Bonis, Alberto Pozzoli, Francesco Nicolini, Filippo Benassi, Davide Pacini, Roberto Di Bartolomeo, Andrea De Martino, Uberto Bortolotti, Roberto Lorusso, Enrico Vizzardi, Gabriele Di Giammarco, Daniele Marinelli, Emmanuel Villa, Giovanni Troise, Domenico Paparella, Vito Margari, Francesco Tritto, Girolamo Damiani, Giuseppe Scrascia, Salvatore Zaccaria, Attilio Renzulli, Giuseppe Serraino, Giovanni Mariscalco, Daniele Maselli, Alessandro Parolari, Giannantonio Nappi

^*Corresponding author for this work

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

Abstract

OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.

METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.

RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P <0.001), consistent with increasing mean patient age (56 +/- 14, 64 +/- 15, 65 +/- 14 years, respectively, P <0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P <0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P <0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.

CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.

Original language	English
Pages (from-to)	105-111
Number of pages	7
Journal	European Journal of Cardio-Thoracic Surgery
Volume	52
Issue number	1
DOIs	https://doi.org/10.1093/ejcts/ezx045
Publication status	Published - Jul 2017
Event	30th EACTS Annual Meeting - Centre de Convencions Internacional de Barcelona (CCIB), Barcelona, Spain Duration: 1 Oct 2016 → 5 Oct 2016 http://www.barcelocongresos.com.es/eacts2016/

Keywords

Early outcomes
Infective endocarditis
Prosthetic valve endocarditis
Surgery
Predictors
INFECTIVE ENDOCARDITIS
INTERNATIONAL-COLLABORATION
EPIDEMIOLOGY
MANAGEMENT
MORTALITY

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10.1093/ejcts/ezx045

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Della Corte, A., Di Mauro, M., Dato, G. A., Barili, F., Cugola, D., Gelsomino, S., Sante, P., Carozza, A., Della Ratta, E., Galletti, L., Devotini, R., Casabona, R., Santini, F., Salsano, A., Scrofani, R., Antona, C., De Vincentiis, C., Biondi, A., Beghi, C., ... Nappi, G. (2017). Surgery for prosthetic valve endocarditis: a retrospective study of a national registry. European Journal of Cardio-Thoracic Surgery, 52(1), 105-111. https://doi.org/10.1093/ejcts/ezx045

@article{4249fe6a7a3d4f1094fb5f16e6c895ba,

title = "Surgery for prosthetic valve endocarditis: a retrospective study of a national registry",

abstract = "OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.RESULTS: Overall hospital (30-day) mortality was 19.2\% (112 patients). Postoperative complications of any type occurred in 256 patients (44\%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4\%, 17.1\%, 20.5\%, respectively, P = 0.60), whereas complication rate increased (18.5\%, 38.2\%, 52.8\%, P <0.001), consistent with increasing mean patient age (56 +/- 14, 64 +/- 15, 65 +/- 14 years, respectively, P <0.001) and median logistic EuroSCORE (14\%, 21\%, 23\%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P <0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P <0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.",

keywords = "Early outcomes, Infective endocarditis, Prosthetic valve endocarditis, Surgery, Predictors, INFECTIVE ENDOCARDITIS, INTERNATIONAL-COLLABORATION, EPIDEMIOLOGY, MANAGEMENT, MORTALITY",

author = "\{Della Corte\}, Alessandro and \{Di Mauro\}, Michele and Dato, \{Guglielmo Actis\} and Fabio Barili and Diego Cugola and Sandro Gelsomino and Pasquale Sante and Antonio Carozza and \{Della Ratta\}, Ester and Lorenzo Galletti and Roger Devotini and Riccardo Casabona and Francesco Santini and Antonio Salsano and Roberto Scrofani and Carlo Antona and \{De Vincentiis\}, Carlo and Andrea Biondi and Cesare Beghi and Giangiuseppe Cappabianca and \{De Bonis\}, Michele and Alberto Pozzoli and Francesco Nicolini and Filippo Benassi and Davide Pacini and \{Di Bartolomeo\}, Roberto and \{De Martino\}, Andrea and Uberto Bortolotti and Roberto Lorusso and Enrico Vizzardi and \{Di Giammarco\}, Gabriele and Daniele Marinelli and Emmanuel Villa and Giovanni Troise and Domenico Paparella and Vito Margari and Francesco Tritto and Girolamo Damiani and Giuseppe Scrascia and Salvatore Zaccaria and Attilio Renzulli and Giuseppe Serraino and Giovanni Mariscalco and Daniele Maselli and Alessandro Parolari and Giannantonio Nappi",

year = "2017",

month = jul,

doi = "10.1093/ejcts/ezx045",

language = "English",

volume = "52",

pages = "105--111",

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

issn = "1010-7940",

publisher = "European Association for Cardio-Thoracic Surgery",

number = "1",

note = "30th EACTS Annual Meeting ; Conference date: 01-10-2016 Through 05-10-2016",

url = "http://www.barcelocongresos.com.es/eacts2016/",

}

Della Corte, A, Di Mauro, M, Dato, GA, Barili, F, Cugola, D, Gelsomino, S, Sante, P, Carozza, A, Della Ratta, E, Galletti, L, Devotini, R, Casabona, R, Santini, F, Salsano, A, Scrofani, R, Antona, C, De Vincentiis, C, Biondi, A, Beghi, C, Cappabianca, G, De Bonis, M, Pozzoli, A, Nicolini, F, Benassi, F, Pacini, D, Di Bartolomeo, R, De Martino, A, Bortolotti, U, Lorusso, R, Vizzardi, E, Di Giammarco, G, Marinelli, D, Villa, E, Troise, G, Paparella, D, Margari, V, Tritto, F, Damiani, G, Scrascia, G, Zaccaria, S, Renzulli, A, Serraino, G, Mariscalco, G, Maselli, D, Parolari, A & Nappi, G 2017, 'Surgery for prosthetic valve endocarditis: a retrospective study of a national registry', European Journal of Cardio-Thoracic Surgery, vol. 52, no. 1, pp. 105-111. https://doi.org/10.1093/ejcts/ezx045

TY - JOUR

T1 - Surgery for prosthetic valve endocarditis

T2 - 30th EACTS Annual Meeting

AU - Della Corte, Alessandro

AU - Di Mauro, Michele

AU - Dato, Guglielmo Actis

AU - Barili, Fabio

AU - Cugola, Diego

AU - Gelsomino, Sandro

AU - Sante, Pasquale

AU - Carozza, Antonio

AU - Della Ratta, Ester

AU - Galletti, Lorenzo

AU - Devotini, Roger

AU - Casabona, Riccardo

AU - Santini, Francesco

AU - Salsano, Antonio

AU - Scrofani, Roberto

AU - Antona, Carlo

AU - De Vincentiis, Carlo

AU - Biondi, Andrea

AU - Beghi, Cesare

AU - Cappabianca, Giangiuseppe

AU - De Bonis, Michele

AU - Pozzoli, Alberto

AU - Nicolini, Francesco

AU - Benassi, Filippo

AU - Pacini, Davide

AU - Di Bartolomeo, Roberto

AU - De Martino, Andrea

AU - Bortolotti, Uberto

AU - Lorusso, Roberto

AU - Vizzardi, Enrico

AU - Di Giammarco, Gabriele

AU - Marinelli, Daniele

AU - Villa, Emmanuel

AU - Troise, Giovanni

AU - Paparella, Domenico

AU - Margari, Vito

AU - Tritto, Francesco

AU - Damiani, Girolamo

AU - Scrascia, Giuseppe

AU - Zaccaria, Salvatore

AU - Renzulli, Attilio

AU - Serraino, Giuseppe

AU - Mariscalco, Giovanni

AU - Maselli, Daniele

AU - Parolari, Alessandro

AU - Nappi, Giannantonio

PY - 2017/7

Y1 - 2017/7

N2 - OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P <0.001), consistent with increasing mean patient age (56 +/- 14, 64 +/- 15, 65 +/- 14 years, respectively, P <0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P <0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P <0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.

AB - OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P <0.001), consistent with increasing mean patient age (56 +/- 14, 64 +/- 15, 65 +/- 14 years, respectively, P <0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P <0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P <0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.

KW - Early outcomes

KW - Infective endocarditis

KW - Prosthetic valve endocarditis

KW - Surgery

KW - Predictors

KW - INFECTIVE ENDOCARDITIS

KW - INTERNATIONAL-COLLABORATION

KW - EPIDEMIOLOGY

KW - MANAGEMENT

KW - MORTALITY

U2 - 10.1093/ejcts/ezx045

DO - 10.1093/ejcts/ezx045

M3 - Article

C2 - 28329161

SN - 1010-7940

VL - 52

SP - 105

EP - 111

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

IS - 1

Y2 - 1 October 2016 through 5 October 2016

ER -

Surgery for prosthetic valve endocarditis: a retrospective study of a national registry

Abstract

Keywords

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