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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Main 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
Format: Article
Language:English
Published: BMC 2020-02-01
Series:BMC Cardiovascular Disorders
Subjects:
PVE
Online Access:https://doi.org/10.1186/s12872-020-01338-y
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spelling 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
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