Severity of Presentation, Not Sex, Increases Risk of Surgery for Infective Endocarditis

Weber, Carolyn; Gassa, Asmae; Rokohl, Alexander C.; Sabashnikov, Anton; Deppe, Antje‐Christin; Eghbalzadeh, Kaveh; Merkle, Julia; Hamacher, Stefanie; Liakopoulos, Oliver J.; Wahlers, Thorsten

doi:10.1016/j.athoracsur.2018.10.033

Cited by 28 publications

(54 citation statements)

References 23 publications

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“…Cardiac surgery for IE was indicated according to the recent European Society of Cardiology (ESC) guidelines for the management of IE (15) and performed as previously described (16). The type of surgery was performed according to the surgeon's preference and the extent of infection, with the aim of achieving radical debridement of infected tissue.…”

Section: Operative Proceduresmentioning

confidence: 99%

Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery

Weber¹,

Gassa²,

Eghbalzadeh³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: There has been an increasing incidence of right-sided infective endocarditis (RSIE) due to the global rise of intravenous drug use (IVDU) and an increasing number of implantable cardiac electronic devices and central venous catheters. Our aim was to investigate differences in the clinical presentation, microbiological findings and prognosis of patients undergoing surgery for RSIE compared to left-sided infective endocarditis (LSIE). Methods: Relevant clinical data of all 432 consecutive patients undergoing valve surgery for infective endocarditis (IE) at our institution between January 2009 and December 2018 were retrospectively analyzed. Acquired data included patients' demographic and preoperative comorbidities, manifestation of IE according to the recently modified Duke Criteria, perioperative data and relevant clinical outcomes. Results: A total of 403 patients (93.3%) underwent surgery for LSIE and twenty-nine patients (6.7%) for RSIE. Eleven patients with RSIE (37.9%) showed a concomitant left-sided infection. Compared to LSIE, RSIE patients were significantly younger [47.5 (40.4-69.3) vs. 65.1 (53.7-74.6); P=0.008] and presented with less comorbidities such as hypertension (41.4% vs. 65.3%; P=0.010) and coronary artery disease (6.9% vs. 29.0%; P=0.010). Rates of IVDU (34.5% vs. 4.5%; P<0.001), human immunodeficiency virus (HIV) (10.3%vs. 1.7%; P=0.023) and hepatitis C virus (HCV) infection (24.1% vs. 5.2%; P=0.001) were greater in RSIE.The proportion of Staphylococcus aureus IE was significantly higher in RSIE compared to LSIE (37.9% vs. 21.1%; P=0.035). 30-day mortality was 6.9% after surgery for RSIE compared to 14.6% after operation for LSIE (P=0.372). Conclusions:Patients undergoing surgery for RSIE compared to LSIE presented with a higher rate of pulmonary septic emboli, more Staphylococcus aureus infections and larger vegetations. Larger multicenter prospective trials are needed to provide more reliable data on the clinical profile of these patients, in order to determine optimal surgical management.

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Section: Operative Proceduresmentioning

confidence: 99%

Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery

Weber¹,

Gassa²,

Eghbalzadeh³

et al. 2019

Ann. Cardiothorac. Surg.

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“…Moreover, a recent systematic review of observational series from Portugal 17 concluded that a higher prevalence of men was noted in all studies and this predominance was also noted in all surgical series (men constituted more than two-thirds of all operated patients). Still, scarce and conflicting evidence persists regarding the influence of gender on the access to cardiac surgery and fatal outcome, [18][19][20][21][22][23][24] being mostly based on single-center cohorts. Populational studies addressing this issue are rare, 23 yet crucial to avoid selection bias in observational studies performed in tertiary centers.…”

Section: Discussionmentioning

confidence: 99%

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal – How do Women and Men Compare?

Sousa¹,

Nogueira²,

Pinto³

2021

International Journal of Cardiovascular Sciences

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Cardiovascular diseases, including coronary heart disease, heart failure, and cerebrovascular disease, constitute leading causes of cardiovascular morbidity and mortality worldwide. 1 Great advances in cardiovascular prevention and management 2-4 have dramatically altered the outcome of these patients. Still, this trend has not been homogeneous between men and women. In the last decades, a growing awareness of the similarities and differences between men and women regarding cardiovascular function, disease burden, and epidemiology has been noted. Several initiatives issued by scientific societies have increasingly

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“…IE was defined according to the recent modified Duke Criteria [13]. Surgery for IE was indicated according to the recent ESC guidelines for the management of infective endocarditis [9] and performed as previously described [14].…”

Section: Definition Of Ie and Indication For Surgerymentioning

confidence: 99%

Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis

Weber

Rahmanian²,

Nitsche

et al. 2020

BMC Cardiovasc Disord

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Background: Cardiac surgery for prosthetic valve endocarditis (PVE) is associated with substantial mortality. We aimed to analyze 30-day and 1-year outcome in patients undergoing surgery for PVE and sought to identify preoperative risk factors for mortality with special regard to perivalvular infection. Methods: We retrospectively analyzed data of 418 patients undergoing valve surgery for infective endocarditis between January 2009 and July 2018. After 1:1 propensity matching 158 patients (79 PVE/79 NVE) were analyzed with regard to postoperative 30-day and 1-year outcomes. Univariate and multivariable analyses were performed to identify potential risk factors for mortality. Results: 315 patients (75.4%) underwent surgery for NVE and 103 (24.6%) for PVE. After propensity matching groups were comparable with regard to preoperative characteristics, clinical presentation and microbiological findings, except a higher incidence of perivalvular infection in patients with PVE (51.9%) compared to NVE (26.6%) (p = 0.001), longer cardiopulmonary bypass (166 [76-130] vs. 97 [71-125] min; p < 0.001) and crossclamp time (95 [71-125] vs. 68 [55-85] min; p < 0.001). Matched patients with PVE showed a 4-fold increased 30-day mortality (20.3%) in comparison with NVE patients (5.1%) (p = 0.004) and 2-fold increased 1-year mortality (PVE 29.1% vs. NVE 13.9%; p = 0.020). Multivariable analysis revealed perivalvular abscess, sepsis, preoperative AKI and PVE as independent risk factors for mortality. Patients with perivalvular abscess had a significantly higher 30-day mortality (17.7%) compared to patients without perivalvular abscess (8.0%) (p = 0.003) and a higher rate of perioperative complications (need for postoperative pacemaker implantation, postoperative cerebrovascular events, postoperative AKI). However, perivalvular abscess did not influence 1-year mortality (20.9% vs. 22.3%; p = 0.806), or long-term complications such as readmission rate or relapse of IE. Conclusions: Patients undergoing surgery for PVE had a significantly higher 30-day and 1-year mortality compared to NVE. After propensity-matching 30-day mortality was still 4-fold increased in PVE compared to NVE. Patients with perivalvular abscess showed a significantly higher 30-day mortality and perioperative complications, whereas perivalvular abscess seems to have no relevant impact on 1-year mortality, the rate of readmission or relapse of IE.

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Severity of Presentation, Not Sex, Increases Risk of Surgery for Infective Endocarditis

Cited by 28 publications

References 23 publications

Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery

Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal – How do Women and Men Compare?

Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis

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