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Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet 2024; 404:377-392. [PMID: 39067905 DOI: 10.1016/s0140-6736(24)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
First described more than 350 years ago, infective endocarditis represents a global health concern characterised by infections affecting the native or prosthetic heart valves, the mural endocardium, a septal defect, or an indwelling cardiac device. Over recent decades, shifts in causation and epidemiology have been observed. Echocardiography remains pivotal in the diagnosis of infective endocarditis, with alternative imaging modalities gaining significance. Multidisciplinary management requiring expertise of cardiologists, cardiovascular surgeons, infectious disease specialists, microbiologists, radiologists and neurologists, is imperative. Current recommendations for clinical management often rely on observational studies, given the limited number of well conducted randomised controlled trials studying infective endocarditis due to the rarity of the disease. In this Seminar, we provide a comprehensive overview of optimal clinical practices in infective endocarditis, highlighting key aspects of pathophysiology, pathogens, diagnosis, management, prevention, and multidisciplinary approaches, providing updates on recent research findings and addressing remaining controversies in diagnostic accuracy, prevention strategies, and optimal treatment.
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Affiliation(s)
- Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Aortic Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B K S Sastry
- Department of Cardiology, Renova Century Hospital, Hyderabad, Telangana, India
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Martínez-Sellés M, Kortajarena-Urkola X, Muñoz P, Fariñas MC, Armiñanzas C, de Alarcón A, Gutiérrez-Carretero E, Rodríguez-García R, Calderón-Parra J, Ramos-Merino L, Cabello-Ubeda A, Miró JM, Goenaga-Sánchez MÁ. Infective endocarditis in HIV-infected patients. Analysis of a national cohort. Infect Dis (Lond) 2024:1-10. [PMID: 39033499 DOI: 10.1080/23744235.2024.2378328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence. METHODS Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021. RESULTS From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm3. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6-1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4-1·3). CONCLUSIONS In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.
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Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense, Madrid, Spain
| | | | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - María Carmen Fariñas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla-IDIVAL. CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Madrid, Spain. Universidad de Cantabria, Santander, Spain
| | - Carlos Armiñanzas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Aristides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP). Grupo de Resistencias bacterianas y antimicrobianos CIBERINFEC. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Department. CIBERCV, Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo. Universidad de Oviedo, Spain
| | - Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro. IDIPHISA, Madrid, Spain
| | - Lucía Ramos-Merino
- Servicio de Enfermedades Infecciosas, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alfonso Cabello-Ubeda
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación sanitaria Fundación Jimenez Díaz (IIS-FJD, UAM), Spain
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Jordal S, Kommedal Ø, Haaverstad R, Saeed S, Davidsen ES, Salminen PR, Hufthammer KO, Kittang BR. Epidemiological and microbial trends of infective endocarditis in western Norway: a 7-year prospective observational study. BMC Infect Dis 2024; 24:702. [PMID: 39020296 PMCID: PMC11256475 DOI: 10.1186/s12879-024-09596-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. METHODS Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. RESULTS The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. CONCLUSIONS The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.
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Affiliation(s)
- Stina Jordal
- Section of Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Øyvind Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Section of Cardiothoracic Surgery, Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | - Pirjo-Riitta Salminen
- Section of Cardiothoracic Surgery, Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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Weber C, Misfeld M, Diab M, Saha S, Elderia A, Marin-Cuartas M, Luehr M, Yagdiran A, Eysel P, Jung N, Hagl C, Doenst T, Borger MA, Kernich N, Wahlers T. Infective endocarditis and spondylodiscitis-impact of sequence of surgical therapy on survival and recurrence rate. Eur J Cardiothorac Surg 2024; 66:ezae246. [PMID: 38964339 DOI: 10.1093/ejcts/ezae246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence. METHODS Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD. RESULTS From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality. CONCLUSIONS Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
- Department of Cardiac Surgery, HKZ Klinikum Herfeld-Rotenburg Rotenburg a.d. Fulda, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ahmed Elderia
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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Huang JB, Lu CC, Wen ZK, Liang SJ. Modifiable risk factors of immediate and long-term outcomes in the operable and inoperable with left-sided infective endocarditis. Heliyon 2024; 10:e32041. [PMID: 38882297 PMCID: PMC11177143 DOI: 10.1016/j.heliyon.2024.e32041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives To evaluate the outcomes of left-sided infective endocarditis that can be operated on and cannot be operated on, and to focus on modifiable risk factors for immediate and long-term mortality. Methods This study retrospectively investigated patients with left-sided infective endocarditis who occurred in our medical center between January 2006 and November 2022. Results 48 in-hospital deaths occurred (5.8 %, 48/832). We identified time from symptoms to admission and symptomatic neurological complications to be risk factors for multiple organ failure upon admission. Time from symptoms to admission and vegetation size in group of isolated medical treatment were significantly shorter than those in the group of heart operation. We also found that preoperative neurological complications, annulus destruction, levels of serum creatinine at 24 and 48 h post heart operation, and perivalvular leakage are risk factors for in-hospital mortality post heart operation. With 148 μmol/L as a cutoff level, the diagnostic sensitivity and specificity of serum creatinine level 48 h post surgery for in-hospital mortality post cardiac surgery are 100 % and 81.6 %, respectively. We found that vegetation size, ICU stay, postoperative serum creatinine at 48 h, left ventricular end diastolic size postoperative, and red blood cell transfusion were associated with all-time mortality. Conclusions Early diagnosis and treatment, improvement of surgical techniques, good protection for heart, kidney and blood and close follow-up are advocated to conduce to better immediate and long-term outcomes of the operable and inoperable with left-sided infective endocarditis.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Sheng-Jing Liang
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
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Mitsutake K, Shinya N, Seki M, Ohara T, Uemura K, Fukunaga M, Sakai J, Nagao M, Sata M, Hamada Y, Kawasuji H, Yamamoto Y, Nakamatsu M, Koizumi Y, Mikamo H, Ukimura A, Aoyagi T, Sawai T, Tanaka T, Izumikawa K, Takayama Y, Nakamura K, Kanemitsu K, Tokimatsu I, Nakajima K, Akine D. Clinical characteristics and analysis of prognostic factors in methicillin-resistant Staphylococcus aureus endocarditis: A retrospective multicenter study in Japan. J Infect Chemother 2024:S1341-321X(24)00157-0. [PMID: 38876203 DOI: 10.1016/j.jiac.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Infective endocarditis (IE) caused by MRSA (methicillin-resistant Staphylococcus aureus) is associated with a high mortality rate. This study aimed to elucidate the characteristics of patients with MRSA-IE in Japan and identify the factors associated with prognosis. METHODS This retrospective study included patients with a confirmed diagnosis of IE caused by MRSA, between January 2015 and April 2019. RESULTS A total of 65 patients from 19 centers were included, with a mean age of 67 years and 26% were female. Fifty percent of the patients with IE were had nosocomial infections and 25% had prosthetic valve involvement. The most common comorbidities were hemodialysis (20%) and diabetes (20%). Congestive heart failure was present in 86% of patients (NYHA class I, II: 48%; III, IV: 38%). The 30-day and in-hospital mortality rates were 29% and 46%, respectively. Multi-organ failure was the primary cause of death, accounting for 43% of all causes of death. Prognostic factors for in-hospital mortality were age, disseminated intravascular coagulation, daptomycin and/or linezolid as initial antibiotic therapy, and surgery. Surgical treatment was associated with a lower mortality rate (odds ratio [OR], 0.026; 95% confidence interval [CI], 0.002-0.382; p=0.008 for 30-day mortality and OR, 0.130; 95% CI; 0.029-0.584; p=0.008 for in-hospital mortality). CONCLUSION Mortality due to MRSA-IE remains high. Surgical treatment is a significant prognostic predictor of MRSA-IE.
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Affiliation(s)
- Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan.
| | - Natsuki Shinya
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan
| | - Masafumi Seki
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan; Department of Infectious Diseases, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku,Sendai, Miyagi 983-8536, Japan
| | - Takahiro Ohara
- Division of Geriatric and Community Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Kohei Uemura
- Department of Biostatistics and Bioinformatics, Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita, Kitakyushu, Fukuoka 802-8555, Japan
| | - Jun Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University Hospital, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto City, Kyoto 606-8507, Japan
| | - Makoto Sata
- National Cerebral and Cardiovascular Center Division of Pulmonology and Infection Control, 6-1, Kishibe Shinmachi, Suita, Osaka 564-8565, Japan
| | - Yohei Hamada
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Masashi Nakamatsu
- Department of Infection control, University of the Ryukyus Hospital, 207 Aza-Uehara, Nishihara, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Iwasaku, Ganmata, Nagakute, Aichi 480-1195, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Iwasaku, Ganmata, Nagakute, Aichi 480-1195, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-cho, Takatsuki, Osaka 569-0801, Japan
| | - Tetsuji Aoyagi
- Department of Clinical Microbiology and Infection, Tohoku University Graduate School of Medicine, Department of Comprehensive Infectious Diseases, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Toyomitsu Sawai
- Nagasaki Harbor Medical Center, Department of Respiratory Medicine, 6-39 Shinchi-cho, Nagasaki City, Nagasaki 850-0842, Japan
| | - Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, 1 Chome-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1 Chome-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yoko Takayama
- Department of Infection Control and Infectious Diseases Research and Development Center for New Medical Frontiers Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Issei Tokimatsu
- Department of Medicine, Division of Clinical Infectious Diseases, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kazuhiko Nakajima
- Department of Infection Prevention and Control, Hyogo medical University, 1-1, Mukogawa, Nishinomiya, Hyogo 663-850, Japan
| | - Dai Akine
- Division of Clinical infectious diseases, School of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Li H, Li Y, Jia Z, Ren L, Nappi F, Ma X, Jiang Y, Han S. Postoperative follow-up of 221 patients with infective endocarditis from Gaoligong mountain area of Yunnan in China: a retrospective, single-center, observational cohort study. J Thorac Dis 2024; 16:3325-3337. [PMID: 38883629 PMCID: PMC11170432 DOI: 10.21037/jtd-24-470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
Background Despite improvements in management, infective endocarditis (IE) is still associated with high mortality and morbidity. The outcome of patients with IE remains unclear in high-altitude areas of China. To characterize the epidemiological features and surgical outcomes, a retrospective analysis was conducted to 221 patients diagnosed with IE from a single center. In addition, to assess the prognosis of patients, a multivariate logistic regression model was performed to analyze the affecting risk factors. Methods A retrospective analysis was conducted on the clinical data of 221 patients with IE who underwent surgical treatment at the Department of Cardiac Surgery of Yan'an Hospital Affiliated to Kunming Medical University from January 2013 to December 2019. The analysis evaluated patient demographics, pathogenic bacterial composition, echocardiography results, and surgical treatment outcomes. After a 1-year follow-up period, the mortality rate was statistically analyzed. The patients were divided into two groups based on their survival status: those who survived and those who did not. Relevant factors were compared between the two groups, and a multivariate logistic regression model was used to analyze the risk factors that affect the prognosis of patients with IE. Results Out of the 221 patients diagnosed with IE, 164 were male and 57 were female, with an average age of 39.25±14.36 years. The most common underlying heart diseases were bicuspid aortic valve disease (24.9%), congenital heart disease (19.5%), rupture of aortic sinus aneurysm (5.0%) and rheumatic valvular disease (2.3%). The blood culture had a positive rate of 48.42% (107/221), with Streptococcus viridans (29.9%) and Streptococcus haematoides (13.1%) being the main specifically pathogenic bacteria identified. Transthoracic echocardiography produced positive results in 89.6% (198/221) of cases. The findings included vegetation formation (100%), valve perforation or tear (21.7%), and perivalvular abscess formation (5.6%). Out of the patients, 174 underwent elective surgery, 47 received emergency surgery, and 11 died within 1 year after surgery, resulting in a mortality rate of 5.0%. However, the death group had longer operation time, cardiopulmonary bypass (CPB) time and higher EuroSCORE II compared to the non-death group (P<0.05). Logistic regression analysis identified preoperative hematocrit decrease, prolonged operation time and CPB time, high New York Heart Association (NYHA) cardiac function grade, and liver diseases as risk factors for 1-year mortality in patients with IE (OR =1.003, 0.000, 1.006, 1.026, 1.624 and 4.746). Conclusions IE primarily affects young and middle-aged men with rheumatic heart valvular disease as the main underlying heart disease and Streptococcus viridans as the main pathogen. Surgical intervention significantly reduces early mortality in IE patients. To improve postoperative prognosis, clinicians should remain vigilant, especially in high-risk groups with preoperative hematocrit, prolonged operation time, and CPB time, high NYHA cardiac function grade, EuroSCORE II, and vegetation formation.
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Affiliation(s)
- Hua Li
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Yaxiong Li
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Zheng Jia
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Le Ren
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, France
| | - Xiao Ma
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Yu Jiang
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Shen Han
- Department of Cardiovascular Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
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Varela-Barca L, López-Menéndez J. Perioperative risk stratification scores in infective endocarditis and its usefulness. Indian J Thorac Cardiovasc Surg 2024; 40:47-60. [PMID: 38827549 PMCID: PMC11139811 DOI: 10.1007/s12055-023-01644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis continues to represent a serious disease worldwide with high morbidity and mortality rates despite advances in diagnosis and treatment. Risk assessment plays a pivotal role in determining the appropriate course of treatment for patients diagnosed with infective endocarditis. In this context, specific endocarditis risk scores have been developed trying to help in the risk assessment process. During the last 15 years, 19 specific endocarditis scores have been published. These newly created scores are very heterogenous in their characteristics, factors included, and validation strategies. The purpose of this review is to analyze the published specific infective endocarditis risk scores and discuss their advantages, limitations, and usefulness. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01644-y.
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Affiliation(s)
- Laura Varela-Barca
- Cardiac Surgery Department, La Princesa University Hospital, Madrid, Spain
| | - Jose López-Menéndez
- Cardiac Surgery Department, Ramón y Cajal University Hospital, Madrid, Spain
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9
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Mestres CA, Quintana E. The changing scenario of infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:4-7. [PMID: 38827551 PMCID: PMC11139810 DOI: 10.1007/s12055-024-01691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Carlos A. Mestres
- Department of Cardiothoracic Surgery and The Robert WM Frater Cardiovascular Research Institute, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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10
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Papadimitriou-Olivgeris M, Monney P, Frank M, Tzimas G, Tozzi P, Kirsch M, Van Hemelrijck M, Bauernschmitt R, Epprecht J, Guery B, Hasse B. Evaluation of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Criteria in a Multicenter Cohort of Patients With Suspected Infective Endocarditis. Clin Infect Dis 2024; 78:949-955. [PMID: 38330243 PMCID: PMC11006096 DOI: 10.1093/cid/ciae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Since publication of Duke criteria for infective endocarditis (IE) diagnosis, several modifications have been proposed. We aimed to evaluate the diagnostic performance of the Duke-ISCVID (International Society of Cardiovascular Infectious Diseases) 2023 criteria compared to prior versions from 2000 (Duke-Li 2000) and 2015 (Duke-ESC [European Society for Cardiology] 2015). METHODS This study was conducted at 2 university hospitals between 2014 and 2022 among patients with suspected IE. A case was classified as IE (final IE diagnosis) by the Endocarditis Team. Sensitivity for each version of the Duke criteria was calculated among patients with confirmed IE based on pathological, surgical, and microbiological data. Specificity for each version of the Duke criteria was calculated among patients with suspected IE for whom IE diagnosis was ruled out. RESULTS In total, 2132 episodes with suspected IE were included, of which 1101 (52%) had final IE diagnosis. Definite IE by pathologic criteria was found in 285 (13%), 285 (13%), and 345 (16%) patients using the Duke-Li 2000, Duke-ESC 2015, or the Duke-ISCVID 2023 criteria, respectively. IE was excluded by histopathology in 25 (1%) patients. The Duke-ISCVID 2023 clinical criteria showed a higher sensitivity (84%) compared to previous versions (70%). However, specificity of the new clinical criteria was lower (60%) compared to previous versions (74%). CONCLUSIONS The Duke-ISCVID 2023 criteria led to an increase in sensitivity compared to previous versions. Further studies are needed to evaluate items that could increase sensitivity by reducing the number of IE patients misclassified as possible, but without having detrimental effect on specificity of Duke criteria.
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Affiliation(s)
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias Van Hemelrijck
- Department of Cardiac Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Robert Bauernschmitt
- Department of Cardiac Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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11
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de Waha S, Desch S, Tilz R, Vogler J, Uhlemann M, Marín-Cuartas M, Raschpichler M, Borger M. [ESC guidelines 2023 on the management of endocarditis : What is new?]. Herz 2024; 49:33-42. [PMID: 38092975 DOI: 10.1007/s00059-023-05225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/26/2024]
Abstract
In August 2023 the new European guidelines on the management of infective endocarditis were published by the European Society of Cardiology (ESC). Numerous recommendations were revised and supplemented by new ones. This review article outlines the essential modifications of the current ESC guidelines focusing on the prevention including antibiotic prophylaxis, the role of the endocarditis team, the revision of the diagnostic criteria, the paradigm shift towards oral antibiotic treatment, the timing and the indications for surgical treatment as well as the relevance of infections of cardiovascular implantable electronic devices.
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Affiliation(s)
- Suzanne de Waha
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Steffen Desch
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Roland Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Julia Vogler
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Madlen Uhlemann
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Mateo Marín-Cuartas
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Matthias Raschpichler
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Michael Borger
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
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12
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Novelli A, Ingason AB, Jirka C, Callas P, Hirashima F, Lovoulos C, Dauerman HL, Polomsky M. Impact of the COVID-19 Pandemic on Infective Endocarditis Management and Outcomes: Analysis of a National Clinical Database. Am J Cardiol 2023; 209:224-231. [PMID: 37922610 DOI: 10.1016/j.amjcard.2023.08.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 11/07/2023]
Abstract
COVID-19 has widely affected health care delivery, but its impact on the management of infective endocarditis (IE), including valve surgery, is uncertain. We compared the national trends in admissions, demographics, and outcomes of IE before and after COVID-19 onset, using a national sample of IE admissions between 2016 and 2022 from the Vizient Clinical Database. The pre-COVID-19 and post-COVID-19 time periods were separated by the start of the second quarter of 2020, the time during which the COVID-19 pandemic was declared. For all admissions and for admissions involving valve surgery, pre-COVID-19 versus post-COVID-19 baseline characteristics and outcomes were compared using 2-sample t tests or chi-square tests. Propensity score-matched cohorts were similarly compared. Before COVID-19, there were 82,867 overall and 11,337 valve-related surgical admissions, and after COVID-19, there were 45,672 overall and 6,322 valve-related surgical admissions. In the matched analysis for all admissions, the in-hospital mortality increased from 11.4% to 12.4% after COVID-19 onset (p <0.001); in-hospital stroke (4.9% vs 6.0%, p <0.001), myocardial infarction (1.3% vs 1.4%, p = 0.03), and aspiration pneumonia (1.8% vs 2.4%, p <0.001) also increased, whereas other complications remained stable. In the matched analysis of surgical admissions, there was decreased in-hospital mortality (7.7% vs 6.7%, p = 0.03) and intensive care unit stay (8.5 ± 12.5 vs 8.0 ± 12.6 days, p = 0.04); other outcomes remained stable. In conclusion, patients admitted with IE after COVID-19 were more medically complex with worsened outcomes and mortality, whereas patients who underwent valve surgery had stable outcomes and improved mortality despite the pandemic.
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Affiliation(s)
- Alexandra Novelli
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Arnar B Ingason
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Caroline Jirka
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Peter Callas
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Fuyuki Hirashima
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Constantinos Lovoulos
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Marek Polomsky
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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13
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Monari C, Molinari D, Cornelli A, Alessio L, Coppolino F, Barbareschi C, De Pascalis S, Torella M, Cimmino G, De Feo M, Coppola N, Formisano T. An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature. Infect Dis Rep 2023; 15:494-503. [PMID: 37736996 PMCID: PMC10514809 DOI: 10.3390/idr15050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Alessandro Cornelli
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Loredana Alessio
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy;
| | - Consiglia Barbareschi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Stefania De Pascalis
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Giovanni Cimmino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
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14
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Galeone A, Gardellini J, Di Nicola V, Perrone F, Boschetti V, Di Gaetano R, Onorati F, Luciani GB. Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1060. [PMID: 37374264 DOI: 10.3390/medicina59061060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient's age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient's age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis.
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Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Jacopo Gardellini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Venanzio Di Nicola
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Fabiola Perrone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Vincenzo Boschetti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Renato Di Gaetano
- Department of Cardiology, Azienda Sanitaria dell'Alto Adige, 39100 Bolzano, Italy
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
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