Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis
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 perivalvula...
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doaj-94f44d26a4474acd8350ac73fc06e0952021-02-07T12:26:05ZengBMCBMC Cardiovascular Disorders1471-22612020-02-0120111110.1186/s12872-020-01338-yHigher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditisCarolyn Weber0Parwis B. RahmanianMelanie Nitsche1Asmae Gassa2Kaveh Eghbalzadeh3Stefanie Hamacher4Julia Merkle5Antje-Christin Deppe6Anton Sabashnikov7Elmar W. Kuhn8Oliver J. Liakopoulos9Thorsten Wahlers10Department of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneInstitute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneDepartment of Cardiothoracic Surgery, University of CologneAbstract 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.https://doi.org/10.1186/s12872-020-01338-yProsthetic valve endocarditisPVEPerivalvular infectionPerivalvular abscess |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
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 |
spellingShingle |
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 Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis BMC Cardiovascular Disorders Prosthetic valve endocarditis PVE Perivalvular infection Perivalvular abscess |
author_facet |
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 |
author_sort |
Carolyn Weber |
title |
Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
title_short |
Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
title_full |
Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
title_fullStr |
Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
title_full_unstemmed |
Higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
title_sort |
higher incidence of perivalvular abscess determines perioperative clinical outcome in patients undergoing surgery for prosthetic valve endocarditis |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2020-02-01 |
description |
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. |
topic |
Prosthetic valve endocarditis PVE Perivalvular infection Perivalvular abscess |
url |
https://doi.org/10.1186/s12872-020-01338-y |
work_keys_str_mv |
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