Mid-term results of surgical treatment for prosthetic valve endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAO Chunrong ,  MEI Ju , DING Fangbao , ZHANG Yunjiao , ZHANG Li , TANG Min , ZHU Jiaquan , MA Nan , ZHANG Junwen

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Heart valve prostheses implantation; prosthetic valve endocarditis; cardiac surgery procedure

DOI：

10.7507/1007-4848.201704022

Video：

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Objective To analyze the mid-term results of surgical treatment for prosthetic valve endocarditis (PVE). Methods We retrospectively analyzed the clinical data of 22 PVE patients operated in our institution from January 2006 to June 2016. There were 14 males and 8 females, aged 31-62 (49.6±11.8) years. PVE occurred following single valve replacements in 20 patients, including aortic valve replacements in 12 and mitral valve replacements in 8. Two patients suffered PVE after multi-valve replacement, which was aortic and mitral valves. Mechanical valves were used in all patients. Early PVE (<1 year after valve implantation) was detected in 10 patients, and late PVE (>1 year after valve implantation) in 12 patients. Blood culture was negative in 6 patients. Fifteen patients underwent emergent or urgent surgery (within one week after definite diagnosis) and 7 elective surgery. Paravalvular abscess was detected in 12 patients and repaired bovine pericardium. Results Three patients (13.6%) died postoperatively in hospital, among whom two died of multiple systemic organ failure, and the other died of cerebral hemorrhage. Main postoperative complications included low cardiac output syndrome in 5 patients (22.7%), renal dysfunction in 6 (27.3%), respiratory failure in 5 (22.7%) and pulmonary infection in 4 (18.2%). During the follow-up of 6-120 (53.6±20.8) months, 2 deaths were observed in the middle term, including one sudden death and the other of cerebral infarction. No recurrent infection or valve-related surgery was observed during the follow-up. The survival rate was 86.4% in 1 year and 70.4% in 5 years. Conclusion PVE is a very severe disease with high mortality. Early surgical treatment and complete removal of infectious tissues have preferable early- and mid-term results.

Citation： BAO Chunrong, MEI Ju, DING Fangbao, ZHANG Yunjiao, ZHANG Li, TANG Min, ZHU Jiaquan, MA Nan, ZHANG Junwen. Mid-term results of surgical treatment for prosthetic valve endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 687-691. doi: 10.7507/1007-4848.201704022 Copy

1.	VongpatanasinW, Hillis LD, Lange RA, et al. Prosthetic heart valves. N Engl J Med, 1996, 335(6): 407-416.
2.	Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA, 2007, 297(12): 1354-1361.
3.	Habib G, Thuny F, Avierinos JF, et al. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis, 2008, 50(4): 274-281.
4.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J, 2015, 36(44): 3075-3128.
5.	Luk A, Kim ML, Ross HJ, et al. Native and prosthetic valve infective endocarditis: clinicopathologic correlation and review of the literature. Malays J Pathol, 2014, 36(2): 71-81.
6.	Mugge A, Daniel WG, Frank G, et al. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol, 1989, 14(3): 631-638.
7.	Pizzi MN, Roque A, Fernández-Hidalgo N, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation, 2015, 132(12): 1113-1126.
8.	Habib G, Tribouilloy C, Thuny F, et al. Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases. Heart, 2005, 91(7): 954-959.
9.	Elbey MA, Kalkan ME, Akdag S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J, 2013, 20(3): 323-328.
10.	Chirouze C, Alla F, Fowler VG Jr, et al. 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, 60(5): 741-749.
11.	Pang PY, Sin YK, Lim CH, et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg, 2015, 47(5): 826-832.
12.	Edlin P, Westling K, Sartipy U. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg, 2013, 95(5): 1551-1556.
13.	Meszaros K, Nujic S, Sodeck GH, et al. Long-term results after operations for active infective endocarditis in native and prosthetic valves. Ann Thorac Surg, 2012, 94(4): 1204-1210.
14.	Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg, 2012, 93(2): 489-493.
15.	Lalani T, Chu VH, Park LP, et al. In-hospital and 1-year mortality in patients undergoing early surgery forprosthetic valve endocarditis. JAMA Intern Med, 20139, 173(16): 1495-1504.
16.	梅举, 丁芳宝, 鲍春荣, 等. 主动脉瓣心内膜炎伴瓣周脓肿的手术治疗. 上海交通大学学报(医学版), 2007, 27(11): 1346-1348.

1. VongpatanasinW, Hillis LD, Lange RA, et al. Prosthetic heart valves. N Engl J Med, 1996, 335(6): 407-416.
2. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA, 2007, 297(12): 1354-1361.
3. Habib G, Thuny F, Avierinos JF, et al. Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis, 2008, 50(4): 274-281.
4. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J, 2015, 36(44): 3075-3128.
5. Luk A, Kim ML, Ross HJ, et al. Native and prosthetic valve infective endocarditis: clinicopathologic correlation and review of the literature. Malays J Pathol, 2014, 36(2): 71-81.
6. Mugge A, Daniel WG, Frank G, et al. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol, 1989, 14(3): 631-638.
7. Pizzi MN, Roque A, Fernández-Hidalgo N, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation, 2015, 132(12): 1113-1126.
8. Habib G, Tribouilloy C, Thuny F, et al. Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases. Heart, 2005, 91(7): 954-959.
9. Elbey MA, Kalkan ME, Akdag S, et al. Predictors of mortality in patients with prosthetic valve infective endocarditis: a nation-wide multicenter study. Cardiol J, 2013, 20(3): 323-328.
10. Chirouze C, Alla F, Fowler VG Jr, et al. 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, 60(5): 741-749.
11. Pang PY, Sin YK, Lim CH, et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg, 2015, 47(5): 826-832.
12. Edlin P, Westling K, Sartipy U. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg, 2013, 95(5): 1551-1556.
13. Meszaros K, Nujic S, Sodeck GH, et al. Long-term results after operations for active infective endocarditis in native and prosthetic valves. Ann Thorac Surg, 2012, 94(4): 1204-1210.
14. Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg, 2012, 93(2): 489-493.
15. Lalani T, Chu VH, Park LP, et al. In-hospital and 1-year mortality in patients undergoing early surgery forprosthetic valve endocarditis. JAMA Intern Med, 20139, 173(16): 1495-1504.
16. 梅举, 丁芳宝, 鲍春荣, 等. 主动脉瓣心内膜炎伴瓣周脓肿的手术治疗. 上海交通大学学报(医学版), 2007, 27(11): 1346-1348.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid-term results of surgical treatment for prosthetic valve endocarditis

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