Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience

• Published in: The Annals of thoracic surgery Vol. 101; no. 4; pp. 1426 - 1432
• Main Authors: Perrotta, Sossio, MD, Jeppsson, Anders, MD, PhD, Fröjd, Victoria, MD, PhD, Svensson, Gunnar, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve; Bioprosthesis - adverse effects; Cardiothoracic Surgery; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - etiology; Endocarditis, Bacterial - surgery; Female; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation; Humans; Kirurgi; Male; Middle Aged; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Retrospective Studies; Surgery; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.07.082

Background Despite progress in diagnostic methods and treatment, aortic prosthetic valve endocarditis (PVE) remains a life-threatening disease. We report the outcome of all operations for aortic PVE performed at our institution over the past 20 years. Methods Eighty-seven operations performed in 84 patients between 1993 and 2013 were included in this retrospective study. An aortic homograft was used in 56 (64%) cases, a mechanical prosthesis was used in 20 (23%) cases, and a bioprosthesis was used in 11 (13%) cases. Early and late complications and mortality were compared between the first and second decades of our experience. Predictors of mortality were identified with Cox regression. Mean follow-up was 5.5 years (range 0–17 years). Results Nine patients (10%) died within 30 days, and severe perioperative complications occurred in 36 patients (41%). Overall cumulative survival was 80% at 5 years and 65% at 10 years. Four (12.9%) of the patients treated with mechanical or biological prostheses had a recurrent episode of endocarditis, compared with none of the patients treated with homografts ( p  = 0.006). During the second decade, 30-day mortality was lower (3.6% versus 22%; p  = 0.007) and 5-year cumulative survival was higher (88% versus 66%; p  = 0.027). Age, preoperative serum creatinine, and severe perioperative complications were independent predictors of mortality during follow-up. Conclusions Aortic PVE is associated with a high rate of early complications and substantial early mortality. Patients who survive the immediate postoperative period have satisfactory long-term survival. The risk of recurrent endocarditis is low, especially in patients treated with homografts. The results have improved during the past decade.