Redo aortic valve surgery: Influence of prosthetic valve endocarditis on outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 142; no. 1; pp. 99 - 105
• Main Authors: Leontyev, Sergey, MD, Borger, Michael A., MD, PhD, Modi, Paul, MD, FRCS, Lehmann, Sven, MD, Seeburger, Jörg, MD, Walther, Thomas, MD, PhD, Mohr, Friedrich W., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2011; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Valve - surgery; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Endocardial and cardiac valvular diseases; Endocarditis - etiology; Endocarditis - mortality; Endocarditis - surgery; Female; Germany; Heart; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Middle Aged; Odds Ratio; Pneumology; Proportional Hazards Models; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - mortality; Prosthesis-Related Infections - surgery; Registries; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; Time Factors; Treatment Outcome; Germany; NYHA; OR; aortic valve replacement; CI; 35.3.4; 35.3.3; odds ratio; prosthetic valve endocarditis; 35.2; New York Heart Association; 41.1; confidence interval; CABG; AVR; PVE; coronary artery bypass grafting; Prognosis; Prosthesis; Heart disease; Endocardial disease; Endocarditis; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Heart valve; Aortic valve
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.08.042

Objective Compared with reoperative aortic valve replacement for nonendocarditic causes, the contemporary risk and long-term outcomes of reoperation for aortic prosthetic valve endocarditis are ill-defined. Methods Between December 1994 and April 2008, 313 patients underwent reoperative aortic valve replacement, of whom 152 (48.6%) had prosthetic valve endocarditis. Mean follow-up was 6.5 ± 0.4 years and 97.4% complete. Results Patients with prosthetic valve endocarditis were older with a higher risk profile. The overall hospital mortality was 15.3% (n = 48) (prosthetic valve endocarditis vs nonendocarditis: 24.3%, n = 37, vs 6.8%, n = 11; P  < .001). Independent predictors of perioperative mortality for prosthetic valve endocarditis were sepsis (odds ratio [OR], 6.5; 95% confidence interval [CI], 2.0–21.0; P  < .01), ejection fraction less than 30% (OR, 5.8; 95% CI, 1.3–25.0; P  = .02), concomitant coronary artery bypass grafting (OR, 3.3; 95% CI, 1.1–9.8; P  = .03), and aortic root abscess (OR, 2.7; 95% CI, 1.2–6.4; P  = .02), and for the nonendocarditis group were concomitant coronary artery bypass grafting (OR, 8.1; 95% CI, 2.0–33.0; P  < .01), and mitral valve surgery (OR, 4.8; 95% CI, 1.3–17.9; P  = .02). The 1-, 3-, 5-, and 10-year survivals for patients with and without prosthetic valve endocarditis were 52% ± 4% versus 82% ± 3%, 43% ± 5% versus 73% ± 4%, 37% ± 5% versus 63% ± 5%, and 31% ± 7% versus 56% ± 8%, respectively (log rank < 0.001). Predictors of long-term mortality in prosthetic valve endocarditis were sepsis (OR, 3.1; 95% CI, 1.5–4.5; P  < .01) and unstable preoperative status (OR, 1.8; 95% CI, 1.2–3.5; P  = .04), whereas in nonendocarditis patients the only predictor was New York Heart Association class IV (OR, 2.5; 95% CI, 2.8–7.4; P  < .01). Five-year actuarial freedom from endocarditis was 80% ± 0.3% versus 95% ± 0.6% (prosthetic valve endocarditis cersus nonendocarditis; P  = .002). Conclusions Despite contemporary therapy, reoperation for aortic prosthetic valve endocarditis is still associated with relatively high perioperative mortality and limited long-term survival.