Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of Reoperative Valve Replacement in Patients with Prosthetic Valve Endocarditis: A 20-Year Experience

  • Kim, Young Woong (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.06.30
  • Accepted : 2017.09.21
  • Published : 2018.02.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Prosthetic valve endocarditis (PVE) is a serious complication of cardiac valve replacement, and many patients with PVE require reoperation. The aim of this study was to review our institutional 20-year experience of surgical reoperative valve replacement in patients with PVE. Methods: A retrospective study was performed on 84 patients (mean age, $54.8{\pm}12.7years$; 51 males) who were diagnosed with PVE and underwent reoperative valve replacement from January 1995 to December 2016. Results: PVE was found in 1 valve in 61 cases (72.6%), and in 2 or more valves in 23 cases (27.4%). The median follow-up duration was 47.3 months (range, 0 to 250 months). Postoperative complications occurred in 39 patients (46.4%). Reinfection occurred in 6 cases, all within 1 year. The freedom from reinfection rate at 5 years was $91.0%{\pm}3.5%$. The overall survival rates at 5 and 10 years were $64.4%{\pm}5.8%$ and $54.3%{\pm}7.3%$, respectively. In stepwise multivariable Cox proportional hazard models, older age (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.05 to 2.10; p=0.027) and cardiopulmonary bypass (CPB) time (HR, 1.03; 95% CI, 1.00 to 1.01; p=0.033) emerged as independent risk factors for death. Conclusion: Older age and a longer CPB time were associated with an increased risk of overall mortality in PVE patients.

Keywords

References

  1. Arvay A, Lengyel M. Incidence and risk factors of prosthetic valve endocarditis. Eur J Cardiothorac Surg 1988;2:340-6. https://doi.org/10.1016/1010-7940(88)90010-3
  2. Rutledge R, Kim BJ, Applebaum RE. Actuarial analysis of the risk of prosthetic valve endocarditis in 1,598 patients with mechanical and bioprosthetic valves. Arch Surg 1985;120:469-72. https://doi.org/10.1001/archsurg.1985.01390280061013
  3. Akowuah EF, Davies W, Oliver S, et al. Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment. Heart 2003;89:269-72. https://doi.org/10.1136/heart.89.3.269
  4. Habib G, Tribouilloy C, Thuny F, et al. Prosthetic valve endocarditis: who needs surgery?: a multicentre study of 104 cases. Heart 2005;91:954-9. https://doi.org/10.1136/hrt.2004.046177
  5. Romano G, Carozza A, Della Corte A, et al. Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients. J Heart Valve Dis 2004;13:200-8.
  6. Kuyvenhoven JP, van Rijk-Zwikker GL, Hermans J, Thompson J, Huysmans HA. Prosthetic valve endocarditis: analysis of risk factors for mortality. Eur J Cardiothorac Surg 1994; 8:420-4. https://doi.org/10.1016/1010-7940(94)90083-3
  7. Wilson WR, Jaumin PM, Danielson GK, Giuliani ER, Washington JA II, Geraci JE. Prosthetic valve endocarditis. Ann Intern Med 1975;82:751-6. https://doi.org/10.7326/0003-4819-82-6-751
  8. Geraci JE, Dale AJ, McGoon DC. Bacterial endocarditis and endarteritis following cardiac operations. Wis Med J 1963;62:302-15.
  9. Dismukes WE, Karchmer AW, Buckley MJ, Austen WG, Swartz MN. Prosthetic valve endocarditis: analysis of 38 cases. Circulation 1973;48:365-77. https://doi.org/10.1161/01.CIR.48.2.365
  10. Douglas J, Cobbs C. Prosthetic valve endocarditis. In: Kaye D, editor. Infective endocarditis. 2nd ed. New York (NY): Raven Press; 1992. p. 375-96.
  11. Lee JH, Burner KD, Fealey ME, et al. Prosthetic valve endocarditis: clinicopathological correlates in 122 surgical specimens from 116 patients (1985-2004). Cardiovasc Pathol 2011;20:26-35. https://doi.org/10.1016/j.carpath.2009.09.006
  12. Mahesh B, Angelini G, Caputo M, Jin XY, Bryan A. Prosthetic valve endocarditis. Ann Thorac Surg 2005;80: 1151-8. https://doi.org/10.1016/j.athoracsur.2004.11.001
  13. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:1318-30. https://doi.org/10.1056/NEJMra010082
  14. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC): endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-128. https://doi.org/10.1093/eurheartj/ehv319
  15. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014;129:e521-643. https://doi.org/10.1161/CIR.0000000000000031
  16. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007;297:1354-61. https://doi.org/10.1001/jama.297.12.1354
  17. Wang A, Pappas P, Anstrom KJ, et al. The use and effect of surgical therapy for prosthetic valve infective endocarditis: a propensity analysis of a multicenter, international cohort. Am Heart J 2005;150:1086-91. https://doi.org/10.1016/j.ahj.2005.01.023
  18. Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012;93:489-93. https://doi.org/10.1016/j.athoracsur.2011.10.063
  19. Edlin P, Westling K, Sartipy U. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg 2013;95:1551-6. https://doi.org/10.1016/j.athoracsur.2013.03.006
  20. Edwards MB, Ratnatunga CP, Dore CJ, Taylor KM. Thirtyday mortality and long-term survival following surgery for prosthetic endocarditis: a study from the UK heart valve registry. Eur J Cardiothorac Surg 1998;14:156-64. https://doi.org/10.1016/S1010-7940(98)00148-1
  21. Sett SS, Hudon MP, Jamieson WR, Chow AW. Prosthetic valve endocarditis: experience with porcine bioprostheses. J Thorac Cardiovasc Surg 1993;105:428-34.
  22. Guerra JM, Tornos MP, Permanyer-Miralda G, Almirante B, Murtra M, Soler-Soler J. Long term results of mechanical prostheses for treatment of active infective endocarditis. Heart 2001;86:63-8. https://doi.org/10.1136/heart.86.1.63
  23. Kim HW, Joo S, Kim HJ, et al. Active prosthetic valve endocarditis: the clinical profile, laboratory findings and mid-term surgical results. Korean J Thorac Cardiovasc Surg 2009;42:447-55.
  24. Lalani T, Chu VH, Park LP, et al. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med 2013;173: 1495-504. https://doi.org/10.1001/jamainternmed.2013.8203
  25. Moon MR, Miller DC, Moore KA, et al. Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis. Ann Thorac Surg 2001; 71:1164-71. https://doi.org/10.1016/S0003-4975(00)02665-5
  26. Haydock D, Barratt-Boyes B, Macedo T, Kirklin JW, Blackstone E. Aortic valve replacement for active infectious endocarditis in 108 patients: a comparison of freehand allograft valves with mechanical prostheses and bioprostheses. J Thorac Cardiovasc Surg 1992;103:130-9.
  27. Grunenfelder J, Akins CW, Hilgenberg AD, et al. Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis. J Heart Valve Dis 2001;10:694-702.
  28. Lund O, Chandrasekaran V, Grocott-Mason R, et al. Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome. J Thorac Cardiovasc Surg 1999; 117:77-90. https://doi.org/10.1016/S0022-5223(99)70471-X
  29. Grubitzsch H, Schaefer A, Melzer C, Wernecke KD, Gabbieri D, Konertz W. Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment. J Thorac Cardiovasc Surg 2014;148:2052-9. https://doi.org/10.1016/j.jtcvs.2014.05.025
  30. Musci M, Hubler M, Amiri A, et al. Surgical treatment for active infective prosthetic valve endocarditis: 22-year single-centre experience. Eur J Cardiothorac Surg 2010;38: 528-38. https://doi.org/10.1016/j.ejcts.2010.03.019

Cited by

  1. Epidemiological investigation and physician awareness regarding the diagnosis and management of Q fever in South Korea, 2011 to 2017 vol.15, pp.6, 2018, https://doi.org/10.1371/journal.pntd.0009467