Volume 4, Issue 6, December 2016, Page: 26-32
Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension
Mariana Mahia, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Ricardo Ronderos, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Ana Iribarren, Cardiac Imaging Service, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Francisco Nacinovich, Infectology Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Pablo Fernandez Oses, Infectology Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Mariano Vrancic, Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Martín Vivas, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Laura Juarez, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Silvana Resi, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Eduardo Filipini, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Gustavo Avegliano, Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Fernando Piccinini, Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Daniel Navia, Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
Received: Nov. 8, 2016;       Accepted: Mar. 24, 2017;       Published: Apr. 12, 2017
DOI: 10.11648/j.ass.20160406.11      View  1085      Downloads  43
Abstract
Infective endocarditis (IE) is a rare but potentially fatal complication of valve replacement, especially if it is accompanied by periannular extension. In these cases surgical intervention is recommended by consensus and clinical guidelines. However, surgery is frequently delayed or not performed, and the best timing for intervention is still controversial. The aim of this study is to analyze determinants of early surgery of patients with prosthetic valve endocarditis (PVE) with periannular extension (PVEPE) and the influence of timing for surgery in morbidity and mortality in a real clinical scenario. Retrospective analysis of a prospective database registry including 180 consecutive patients with definite diagnosis of endocarditis according to modified Duke`s criteria, admitted between 6/2008 and 1/2016, showed 88 patients (49%) with PVE, 48 (54.5%) of them had periannular extension. The patients with PVEPE were divided in 3 groups according to timing for surgery after admission: GA (17p; <10 days), GB (15p; >10 days) and GC (16p; only medical treatment). We analyzed demographic, clinical, microbiological and echocardiographic variables and we related the treatment strategy selected with in-hospital evolution. Comparing the 3 different groups, we observed that the patients in GA were significantly younger, with a higher frequency of male gender and Staphylococcus spp was significantly the most common microorganism; they had less postoperative complications (64% vs 100%, p: 0.019) and a trend to lower in-hospital mortality (18% vs 46%; p= 0,07). In conclusion, younger male patients with staphylococci PVEPE underwent surgery earlier. This strategy was associated with less anatomical damage and less incidence of postoperative complications with a trend to lower in-hospital mortality.
Keywords
Prosthetic Valve Endocarditis, Endocarditis, Periannular Extension, Early Surgery, Echocardiography
To cite this article
Mariana Mahia, Ricardo Ronderos, Ana Iribarren, Francisco Nacinovich, Pablo Fernandez Oses, Mariano Vrancic, Martín Vivas, Laura Juarez, Silvana Resi, Eduardo Filipini, Gustavo Avegliano, Fernando Piccinini, Daniel Navia, Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension, Advances in Surgical Sciences. Vol. 4, No. 6, 2016, pp. 26-32. doi: 10.11648/j.ass.20160406.11
Copyright
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Wang A, Pappas P, Anstrom KJ, Abrutyn E, Fowler VG, Hoen B, Miro JM, Corey GR, Olaison L, Stafford JA, Mestres CA, Cabell CH; International Collaboration on Endocarditis Investigators. The use and effect of surgical therapy for prosthetic valve infective endocarditis: a propensityanalysis of a multicenter, international cohort. Am Heart J 2005; 150: 1086-91.
[2]
Habib G, Lancellotti P, Antunes M, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erbaa PA, Iung B, Mirob JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, and Zamorano JL. Guidelines for management of infective endocarditis. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine. EurHeartJ 2015; 30: 2369–413.
[3]
Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O'Gara PT, O'Rourke RO and Shah PM. ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008; 118: 887-896.
[4]
San Román J, Vilacosta I, Sarriá C, de la Fuente L, Sanz O, Vega J, Ronderos R, González Pinto A, Jesús Rollán M, Graupner C, Batlle E, Lahulla F, Stoermann W, Portis M, Fernández-Avilés F. Clinical course, microbiologic profile, and diagnosis of periannular complications in prosthetic valve endocarditis. Am J Cardiol 1999, 83 (7): 1075-9.
[5]
Graupner C, Vilacosta I, San Román J, Ronderos R, Sarriá C, Fernández C, Mújica R, Sanz O, Sanmartín JV, Pinto AG. Periannular extension of infective endocarditis. J Am CollCardiol 2002, 39 (7): 1204-11.
[6]
San Román, López J, Vilacosta I, Luaces M, Sarriá C, Revilla A, Ronderos R, Stoermann W, Gómez I, Fernández-Avilés F. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med 2007; 120 (4): 369.e1-7.
[7]
Aksoy O, Sexton DJ, Wang A, Pappas PA, Kourany W, Chu V, Fowler VG Jr, Woods CW, Engemann JJ, Corey GR, Harding T, Cabell CH. Early surgery in patients with infective endocarditis: a propensity score analysis. Clin Infect Dis 2007; 44: 364–72.
[8]
Hill EE, Herregods MC, Vanderschueren S, Claus P, Peetermans WE, Herijgers P. Outcome of patients requiring valve surgery during active infective endocarditis. Ann ThoracSurg. 2008; 85: 1564–9.
[9]
Lalani T, Cabell CH, Benjamin DK, Lasca O, Naber C, Fowler VG, Corey GR, Chu VH, Fenely M, Pachirat O, Tan RS, Watkin R, Ionac A, Moreno A, Mestres CA, Casabé J, Chipigina N, Eisen DP, Spelman D, Delahaye F, Peterson G, Olaison L, Wang A; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation 2010; 121: 1005.
[10]
Bannay A, Hoen B, Duval X, Obadia JF, Selton-Suty C, Le Moing V, Le Moing V, Tattevin P, Iung B, Delahaye F, Alla F; AEPEI Study Group. The impact of valve surgery on short- and long-term mortality in left sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J 2011; 32: 2003–15.
[11]
Funakoshi S, Kaji S, Yamamuro A, Tani T, Kinoshita M, Okada Y, Furukawa Y. Impact of early surgery in the active phase on long-term outcomes in left sidenative valve infective endocarditis. J Thorac Cardiovasc Surg 2011; 142: 836–842 e831.
[12]
Ohara T, Nakatani S, Kokubo Y, Yamamoto H, Mitsutake K, Hanai S. Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nationwide survey in Japan. Int J Cardiol 2013; 167: 2688–94.
[13]
Kang D, Kim S, Kun S, Sun B, Kim D, Yun S, Song J, Choo SJ, Chung C, Song J, Lee J, Sohn D. Early surgery vs Conventional Treatment for Infective Endocarditis. N Engl J Med 2012; 366: 2466-73.
[14]
Habib G, Tribouilloy C, Thuny F, Giorgi R, Brahim A, Amazouz M, Remadi JP, Nadji G, Casalta JP, Coviaux F, Avierinos JF, Lescure X, Riberi A, Weiller PJ, Metras D, Raoult D. Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases. Heart 2005; 91: 954–959.
[15]
Revilla A, López J, Sevilla T, Villacorta E, Sarriá C, Manzano M, Fulquet E, Pozo E, Mota P, Gómez I, Vilacosta I, San Román JA. In-Hospital Prognosis of Prosthetic Valve Endocarditis After Urgent Surgery. Rev Esp Cardiol. 2009; 62 (12): 1388-94.
[16]
Thuny F, Beurtheret S, Mancini J, Gariboldi V, Casalta JP, Riberi A et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensityanalysis. Eur Heart J 2011; 32: 2027–33.
[17]
Narayanan M, Haddad T, Kalil A, Kanmantareddy A, Suri R, Mansour G, Destache C, Baskaran J, Mooss A, Wichman T, Morrow L and Vivekanandan R. Early versus late intervention or medical management for infective endocarditis: a systematic review and meta- analysis. Heart 2016; 1-8.
[18]
Funakoshi S, Kaji S, Yamamuro A, Tani T, Kinoshita M, Okada Y and Furukawa Y. Impact of early surgery in the active phase on long term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg 2011; 142: 836-842.
[19]
Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, Fowler VG Jr, Gordon D, Grossi P, Hannan M, Hoen B, Muñoz P, Rizk H, Kanj SS, Selton-Suty C, Sexton DJ, Spelman D, Ravasio V, Tripodi MF, Wang A. International Collaboration on Endocarditis–Prospective Cohort Study Investigators. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med 2013; 173: 1495–504.
[20]
Prendergast B, Tornos P. Surgery for Infective Endocarditis. Who and When? Circulation 2010; 121: 1141-1152.
[21]
Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A; International Collaboration on Endocarditis (ICE) Investigators. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation 2015; 131 (2): 131-40.
[22]
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96: 200-9.
[23]
Li JS, Sexton DJ, Mick N, Nettles R, Fowler V, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30: 633-8.
[24]
Ronderos RE, Portis M, Stoermann W, Sarmiento C. Are all echocardiographic findings equally predictive for diagnosis in prosthetic endocarditis? J Am SocEchocardiogr 2004; 17 (6): 664-9.
[25]
Chirouze C, Alla F, Fowler VG Jr, Sexton DJ, Corey GR, Chu VH, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B; ICE Prospective Investigators. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis 2015 Mar 1; 60 (5): 741-9.
[26]
Amantha NM, Mahfood HT, Kalil AC, Kanmanthareddy A, Suri RM, Mansour G, Destache CJ, Baskaran J, Mooss AN, Wichman T, Morrow L, Vivekanandan R. Early vs late Surgical Intervention or Medical Management for Infective Endocarditis: a Systematic Review and Meta-Analysis Heart 2016; 102 (12): 950-7.
[27]
Grunenfelder J, Akins CW, Hilgenberg AD, Vlahakes G, Torchiana DF, Madsen JC, MacGillivray TE. Long term results and determinants of mortality after surgery for native and prosthetic endocarditis. J Heart Valve Dis 2001; 10: 694-702.
[28]
Akowuah E, Davies W, Oliver S, Stephens J, Riaz I, Zadik J, Cooper G. Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment. Heart 2003; 89: 269-72.
[29]
Revilla A, Lopez J, Vilacosta I, Villacorta E, Rollan MJ, Echevarria J, Carrascal Y, Di Stefano S, Fulquet E, Rodriguez E, Fiz L, and San Román JA. Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery. Eur Heart J 2007; 28: 65-71.
[30]
Wang A, Athan E, Pappas P, Fowler V, Olaison L, Paré C, Almirante B, Muñoz P, Rizzi M, Naber C, Logar M, Tattevin P, Iarussi DL, Selton-Suty C, Jones SB, Casabé J, Morris A, Corey GR, Cabell CH; International Collaboration on Endocarditis-Prospective cohort Study Investigators. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007; 297: 1354-61.
[31]
Tleyjeh IM and Baddour LM. The potential impact of survivor treatment selection bias on the perceived efficacy of valve surgery in the treatment of infective endocarditis. Clin Infect Dis 2007; 44: 1392-1393.
Browse journals by subject