Higher Incidence of Perivalvular Abscess Determines Perioperative Clinical Outcome in Patients Undergoing Surgery for Prosthetic Valve Endocarditis

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2020 Feb 5

PMID 32013875

Citations 7

Authors

Carolyn Weber

Parwis B Rahmanian

Melanie Nitsche

Asmae Gassa

Kaveh Eghbalzadeh

Stefanie Hamacher

Julia Merkle

Antje-Christin Deppe

Anton Sabashnikov

Elmar W Kuhn

Oliver J Liakopoulos

Thorsten Wahlers

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Advancements and Challenges in the Management of Prosthetic Valve Endocarditis: A Review.

Nappi F Pathogens. 2025; 13(12.

PMID: 39770299 PMC: 11728846. DOI: 10.3390/pathogens13121039.

Reintervention for Acute Aortic Prosthesis Endocarditis: Early and Mid-Term Outcomes.

DAlonzo M, Chabry Y, Melica G, Gallien S, Lim P, Aouate D J Clin Med. 2025; 13(24.

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Coronary embolism in left-sided infective endocarditis. A retrospective analysis from a high-volume surgical centre and review of the literature.

Mazzotta R, Orlandi M, Scheggi V, Marchionni N, Stefano P PLoS One. 2024; 19(12):e0314718.

PMID: 39630824 PMC: 11616836. DOI: 10.1371/journal.pone.0314718.

Perioperative care in infective endocarditis.

Quintana E, Ranchordas S, Ibanez C, Danchenko P, Smit F, Mestres C Indian J Thorac Cardiovasc Surg. 2024; 40(Suppl 1):115-125.

PMID: 38827544 PMC: 11139830. DOI: 10.1007/s12055-024-01740-7.

Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience.

Pizzino F, Paradossi U, Trimarchi G, Benedetti G, Marchi F, Chiappino S J Cardiovasc Dev Dis. 2024; 11(5).

PMID: 38786960 PMC: 11121817. DOI: 10.3390/jcdd11050138.

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