1
|
Pocar M, Barbero C, Marro M, Ferrante L, Costamagna A, Fazio L, La Torre M, Boffini M, Salizzoni S, Rinaldi M. Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era. J Clin Med 2024; 13:4532. [PMID: 39124799 PMCID: PMC11313369 DOI: 10.3390/jcm13154532] [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: 05/02/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan-Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1-1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7-168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L (p = 0.04) and aortic cross-clamp time ≥ 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.
Collapse
Affiliation(s)
- Marco Pocar
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Cristina Barbero
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Matteo Marro
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Luisa Ferrante
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Cardiac Intensive Care Unit, Department of Anaesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Luigina Fazio
- Tissue Bank, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Michele La Torre
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| |
Collapse
|
2
|
Piperata A, Azmoun A, Eker A. Aortic valve replacement with rapid-deployment bioprosthesis in case of infective endocarditis: a literature review. Indian J Thorac Cardiovasc Surg 2024; 40:93-99. [PMID: 38827542 PMCID: PMC11139822 DOI: 10.1007/s12055-024-01736-3] [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: 11/23/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose Recently, the use of rapid deployment (RD) aortic valve prostheses has been introduced for the treatment of aortic valve replacement (AVR), showing excellent hemodynamic performances.According to these data, some groups have proposed new RD valves as an alternative solution in the case of infective aortic endocarditis (IAE) to reduce the use of foreign materials, and the manipulation of the annulus.The aim of this review is to report the results of early clinical experiences with the use of RD bioprostheses in the case of IAE, in order to discuss technical and clinical aspects of this emerging strategy to better elucidate its advantages and limitations as a potential therapeutic solution. Methods An in-depth search of PubMed from January to March 2023 was performed. English-language articles were selected independently by authors following the criteria in order to consider all available experiences (full papers, case reports, and case series) that have investigated the use of RD in case of IAE. Results The use of rapid deployment bioprosthesis represents a bailout strategy in case of severe aortic valve endocarditis and should be evaluated with caution in selected cases. This review collects the first, initial, and pioneering experiences of the use of the RD prosthesis in case of infective endocarditis, particularly when the fragility of the annular tissues precludes a secure anchoring of sutured prostheses.The reduced use of foreign materials by minimizing the number of stitches, the reduced cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the excellent hemodynamic performances associated with the use of RD bioprosthesis represent the most important advantages that could justify their use in the setting of aortic valve endocarditis. Conclusion Although there are few anecdotal experiences, surgical aortic valve replacement with the use of RD represents an emerging strategy in case of aortic valve endocarditis. Its advantages, pros, and cons are under debate, and robust clinical trials are needed to demonstrate its safety and efficacy.
Collapse
Affiliation(s)
- Antonio Piperata
- Cardio-thoracic Center of Monaco, 11 bis Avenue d Ostende, 98000 Monaco, Monaco
| | - Alexandre Azmoun
- Cardio-thoracic Center of Monaco, 11 bis Avenue d Ostende, 98000 Monaco, Monaco
| | - Armand Eker
- Cardio-thoracic Center of Monaco, 11 bis Avenue d Ostende, 98000 Monaco, Monaco
| |
Collapse
|
3
|
Brahmam D, Babu MSS, Menon S, Koshy T. A Copybook Multimodal Imaging in a Case of Aortic Root Abscess-Computed Tomography, Surgical, and Intraoperative Echocardiography Imaging. Ann Card Anaesth 2024; 27:154-155. [PMID: 39206592 PMCID: PMC11095773 DOI: 10.4103/aca.aca_84_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 09/04/2024] Open
Affiliation(s)
- Dodda Brahmam
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - M. S. Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarinath Menon
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
4
|
Galeone A, Gardellini J, Trojan D, Di Nicola V, Di Gaetano R, Faggian G, Luciani GB. Three Decades of Experience with Aortic Prosthetic Valve Endocarditis. J Cardiovasc Dev Dis 2023; 10:338. [PMID: 37623351 PMCID: PMC10456059 DOI: 10.3390/jcdd10080338] [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: 06/25/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male and 29 female, aged 67 ± 12 years, underwent surgery for a-PVE at our institution between 1994 and 2021. Median time from the original cardiac surgery was 1.9 [0.6-5.6] years, and 47 (33%) patients developed an early a-PVE. Of these patients, 73 (51%) underwent aortic valve replacement (AVR) with a biological or mechanical PAV, 12 (8%) underwent aortic root replacement (ARR) with a biological or mechanical PVC, and 59 (42%) underwent AVR or ARR with a CAH. Patients treated with a CAH had significantly more circumferential annular abscess multiple valve involvement, longer CPB and aortic cross-clamping times, and needed more postoperative pacemaker implantation than patients treated with a PAV. No difference was observed in survival, reoperation rates, or recurrence of IE between patients treated with a PAV, a PVC, or a CAH. CAHs are technically more demanding and more often used in patients who have extensive annular abscess and multiple valve involvement. However, the use of CAH is safe in patients with complex a-PVE, and it shows excellent early and long-term outcomes.
Collapse
Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy
| | - Jacopo Gardellini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy
| | | | - Venanzio Di Nicola
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy
| | - Renato Di Gaetano
- Department of Cardiology, Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy
| | - Giuseppe Faggian
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37129 Verona, Italy
| |
Collapse
|
5
|
Fernández-Cisneros A, Andreu A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Castellá M, Miró JM, Quintana E. Does Quality of Life in Survivors of Surgery for Acute Left-Sided Infective Endocarditis Differ from Non-Endocarditis Patients? Microorganisms 2023; 11:microorganisms11041058. [PMID: 37110481 PMCID: PMC10142739 DOI: 10.3390/microorganisms11041058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Surgery for left-sided infective endocarditis (IE) has been demonstrated to improve patients' survival rates but information about quality of life (QoL) after surgery is scarce. The aim of this study was to assess the postoperative outcomes and QoL after surgery for IE patients compared to patients undergoing cardiac surgery for non-IE indications. Adult patients with definite acute left-sided IE were matched 1:1 to patients who underwent cardiac surgery for non-endocarditic purposes from 2014 to 2019. QoL was assessed using the SF-36 survey at the last follow-up. A total of 105 patients were matched. The IE group had higher rates of preoperative stroke (21% vs. 7.6%, p = 0.005) and higher stages of NYHA class (p < 0.001), EuroSCORE II (12.3 vs. 3.0, p < 0.001) and blood cell count abnormalities (p < 0.001). The IE group had higher incidence of low cardiac output syndrome (13.3% vs. 4.8%, p = 0.029), dialysis (10.5% vs 1.0%, p = 0.007) and prolonged mechanical ventilation (16.2% vs. 2.9%, p = 0.002) after surgery. At the last follow-up, subcomponents of the SF-36 QoL survey were not different between the groups. Patients who underwent cardiac surgery for IE demonstrated a higher risk profile with a higher rate of postoperative complications. Once recovered from the acute phase of the disease, the reported QoL at follow-up was comparable to that of matched cardiac patients operated for non-IE purposes.
Collapse
Affiliation(s)
| | - Aida Andreu
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 08036 Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jorge Alcocer
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Manuel Castellá
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jose M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| |
Collapse
|
6
|
Celestin B, Habensus EI, Tubiana S, Préau M, Millot S, Lescure FX, Kerneis C, Para M, Duval X, Iung B. Determinants of adherence to oral hygiene prophylaxis guidelines in patients with previous infective endocarditis. Arch Cardiovasc Dis 2023; 116:176-182. [PMID: 36797077 DOI: 10.1016/j.acvd.2023.01.003] [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: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by low incidence but high mortality. Patients with a history of IE are at highest risk. Adherence to prophylaxis recommendations is poor. We sought to identify determinants of adherence to oral hygiene guidelines on IE prophylaxis in patients with a history of IE. METHODS Using data from the cross-sectional, single-centre POST-IMAGE study, we analysed demographic, medical and psychosocial factors. We defined patients as adherent to prophylaxis if they declared going to the dentist at least annually and brushing their teeth at least twice a day. Depression, cognitive status and quality of life were assessed using validated scales. RESULTS Of 100 patients enrolled, 98 completed the self-questionnaires. Among these, 40 (40.8%) were categorized as adherent to prophylaxis guidelines, and were less likely to be smokers (5.1% vs. 25.0%; P=0.02) or have symptoms of depression (36.6% vs. 70.8%; P<0.01) or cognitive decline (0% vs. 15.5%; P=0.05). Conversely, they had higher rates of: valvular surgery since the index IE episode (17.5% vs. 3.4%; P=0.04), searching for information on IE (61.1% vs. 46.3%, P=0.05), and considering themselves as adherent to IE prophylaxis (58.3% vs. 32.1%; P=0.03). Tooth brushing, dental visits and antibiotic prophylaxis were correctly identified as measures to prevent IE recurrence in 87.7%, 90.8% and 92.8% of patients, respectively, and did not differ according to adherence to oral hygiene guidelines. CONCLUSIONS Self-reported adherence to secondary oral hygiene guidelines on IE prophylaxis is low. Adherence is unrelated to most patient characteristics, but to depression and cognitive impairment. Poor adherence appears related more to a lack of implementation rather than insufficient knowledge. Assessment of depression may be considered in patients with IE.
Collapse
Affiliation(s)
- Bettia Celestin
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; Université Paris-Cité, 75018 Paris, France
| | - Emila Ilic Habensus
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Sarah Tubiana
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Marie Préau
- Social Research Group (GRePS UR4163), Lumière Lyon 2 University, 69007 Lyon, France
| | - Sarah Millot
- Département de Médecine et Chirurgie Orale, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - François-Xavier Lescure
- Université Paris-Cité, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France; Infectious Disease Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Caroline Kerneis
- Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marylou Para
- Université Paris-Cité, 75018 Paris, France; Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Xavier Duval
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Bernard Iung
- Université Paris-Cité, 75018 Paris, France; Cardiology Department, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | |
Collapse
|
7
|
Hansen L, Ozga AK, Klusmeier M, Hillebrand M, Tulun A, Pannek N, Rieß FC. The Freestyle Valve in Severe Necrotizing Aortic Root Endocarditis: Comorbidity Upon Outcome. Thorac Cardiovasc Surg 2023; 71:29-37. [PMID: 33782937 DOI: 10.1055/s-0040-1722652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment of severe necrotizing aortic root endocarditis (SNARE) carries a substantial perioperative risk. As an alternative to homografts, we assessed short-term outcome and future prognosis in patients undergoing root replacement using the Freestyle valve. METHODS Between 2000 and 2018, a total of 45 patients (mean age 70.9 ± 8.3 years, 66% men) underwent aortic root replacement for SNARE using the Freestyle valve. Mean Society of Thoracic Surgeons mortality score and EuroScore II were 22.6% ± 17.1 and 29.3% ± 20.9, respectively. Prosthetic endocarditis was present in 70.1%, and aortic annulus patch repair was performed in 64% of the patients. Median follow-up was 3.6 years (range: 0.1-14.5) and was 100% complete. RESULTS The 30-day mortality was 15.5%. During follow-up, there were no reoperations, while reinfection was suspected in one patient. Survival was significantly inferior to the general population with a standardized mortality ratio of 10.7 (95% confidence interval [CI]: 9.1-12.6) (p < 0.0001). In 30-day survivors and after correction for significant comorbidities in a Cox proportional hazards model, estimated survival probabilities at 1, 5, and 10 years were 98.7 (95% CI: 92.5-99.8%), 94.1 (77.9-98.5%), and 63.8 (28.4-85.2%). Estimated mean difference in survival probability was better for the general population after postoperative year 6, but within the 95% CI for no difference. CONCLUSION Use of the Freestyle valve is reliable solution for the most complex cases with a low rate of reinfection. Early mortality is substantial and caused by the patient's condition and severity of the infection. Excess late mortality can be attributed to patient-specific comorbidities.
Collapse
Affiliation(s)
- Lorenz Hansen
- Department for Cardiac Surgery, Albertinen-Krankenhaus, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | | | | | - Aysun Tulun
- Department for Cardiac Surgery, Albertinen-Krankenhaus, Hamburg, Germany
| | - Nora Pannek
- Department for Cardiac Surgery, Albertinen-Krankenhaus, Hamburg, Germany
| | | |
Collapse
|
8
|
Yousif A, Ali K, Anssar M, Harringer W, El-Essawi A, Brouwer R. A 20-year experience with cryopreserved allografts as the valve replacement of choice in aortic root reconstruction for destructive endocarditis with abscess formation. Interact Cardiovasc Thorac Surg 2022; 35:6628590. [PMID: 35786719 PMCID: PMC9270860 DOI: 10.1093/icvts/ivac188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Afram Yousif
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Khaldoun Ali
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Marcel Anssar
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Wolfgang Harringer
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Aschraf El-Essawi
- Department of Cardiothoracic and Vascular Surgery, University of Göttingen , Göttingen, Germany
| | - René Brouwer
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| |
Collapse
|
9
|
Saha S, Mladenova R, Radner C, Horke KM, Buech J, Schnackenburg P, Ali A, Peterss S, Juchem G, Luehr M, Hagl C, Joskowiak D. Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis. J Clin Med 2022; 11:jcm11133599. [PMID: 35806881 PMCID: PMC9267565 DOI: 10.3390/jcm11133599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.
Collapse
Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
- Correspondence: author:
| | - Ralitsa Mladenova
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
| | - Caroline Radner
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Konstanze Maria Horke
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| |
Collapse
|
10
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6564539. [DOI: 10.1093/ejcts/ezac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/16/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022] Open
|
11
|
Rasmussen TB, Zwisler AD, Risom SS, Sibilitz KL, Christensen J, Bundgaard H, Moons P, Thygesen LC, Lindschou J, Norekvål TM, Berg SK. Comprehensive cardiac rehabilitation for patients following infective endocarditis: results of the randomized CopenHeartIE trial. Eur J Cardiovasc Nurs 2021; 21:261-270. [PMID: 34089600 DOI: 10.1093/eurjcn/zvab047] [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: 12/16/2020] [Revised: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022]
Abstract
AIMS Infective endocarditis is a complex and highly mortal disease requiring lengthy treatment. Physical and mental deconditioning is common. Nonetheless, rehabilitation is virtually unexplored in this population. The aim of this trial was therefore to investigate the effects of cardiac rehabilitation in patients following endocarditis. METHODS AND RESULTS In a randomized trial, adults with left-sided or cardiac device endocarditis were randomized 1:1 to 12 weeks of physical exercise training and five psycho-educational consultations (cardiac rehabilitation) vs. usual care without rehabilitation (control). Primary outcome was mental health measured by SF-36 Mental Component Summary (MCS) at 6 months. Secondary outcome was physical capacity measured by peak oxygen uptake (VO2) at 4 months. Exploratory outcomes were investigated. Low inclusion rate resulted in trial termination before reaching the target sample size. A total of 117 participants (mean age: 60 years, 81% male) were randomized to cardiac rehabilitation (n = 58) or to control (n = 59). Mental health and physical capacity at baseline were generally poor (MCS: 38.9-42.2 points, VO2 peak: 16.1-16.6 mL/kg/min). Cardiac rehabilitation compared with control showed no effect on mental health (MCS: 44.6 points vs. 48.8 points, P = 0.41) or physical capacity (VO2 peak: 19.9 mL/kg/min vs. 18.0 mL/kg/min, P = 0.09). Effects favouring the intervention were identified in exploratory outcomes including general fatigue (P = 0.005), and physical capacity as maximal power (W) (P = 0.005). Adherence to the intervention was 28%. CONCLUSIONS Results indicate no effect of cardiac rehabilitation in patients following endocarditis; however, lack of statistical power and poor adherence render findings inconclusive. Valuable insight into patients' capabilities and safety was gained, and further investigations into rehabilitation needs and modes of delivery in this high-need population should be a future priority.
Collapse
Affiliation(s)
- Trine Bernholdt Rasmussen
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 28, Hellerup 2900, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen O 1014, Denmark
| | - Ann-Dorthe Zwisler
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, Nyborg 5800, Denmark
| | - Signe Stelling Risom
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen O 1014, Denmark.,Institute for Nursing and Nutrition, University College Copenhagen, Tagensvej 86, Copenhagen N 2200, Denmark
| | - Kirstine Lærum Sibilitz
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark
| | - Jan Christensen
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, Nyborg 5800, Denmark.,Department of Occupational and Physiotherapy, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark
| | - Henning Bundgaard
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 35 blok d, Leuven, box 7001, B-3000, Belgium.,Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens backe 1, Göteborg 413 46, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, 46 Sawkins Rd, Rosebank, Cape Town 7700, South Africa
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen K 1455, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Tagensvej 22, Copenhagen N 2200, Denmark
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, Bergen 5021, Norway.,Department of Clinical Science, University of Bergen, Jonas Lies veg 87, Bergen, 5021, Norway
| | - Selina Kikkenborg Berg
- The Heart Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen O 1014, Denmark
| |
Collapse
|
12
|
Cefarelli M, Concistrè G, Montecchiani L, Bianchi G, Berretta P, Margaryan R, Alfonsi J, Murzi M, Solinas M, Di Eusanio M. Bioconduit subannular implantation for aortic root endocarditis after previous cardiac surgery: Results from two Italian centers. J Card Surg 2020; 35:3041-3047. [PMID: 32827184 DOI: 10.1111/jocs.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers. METHODS The series comprised 29 patients (18 males, mean age: 72.3 ± 10.1 years) operated at "Lancisi Cardiovascular Center" of Ancona and "Pasquinucci Heart Hospital" of Massa, Italy, between May 2016 and October 2019. All patients had undergone a previous cardiac surgery. Median Euroscore-II was 12.6%. Following aggressive debridement, a Bioconduit was implanted using a sub-annular implantation technique in all cases. RESULTS Thirty-day mortality was 13.8% (n = 4). Multiorgan failure was cause of death in all cases. Respiratory complications occurred in eight patients (27.6%). Renal complications requiring temporary or permanent dialysis occurred in six (20.7%) and two (6.9%) patients, respectively. Mortality and morbidity were not related to the surgical approach. At 1-year follow-up three patients died and no patients underwent reoperation neither reported endocarditis of the biological conduit. CONCLUSION Considered the high-risk profile of the study cohort, our results suggest safety and efficacy of our approach at 1-year. Indeed, we contend that our subannular implantation of a 100% pericardial valved conduit, allowing an effective abscess exclusion and a conduit anchoring to healthy tissues, can reduce the risk of reinfection and dehiscence.
Collapse
Affiliation(s)
- Mariano Cefarelli
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Concistrè
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Luca Montecchiani
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Bianchi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Rafik Margaryan
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Murzi
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
13
|
Piperata A, Kalscheuer G, Metras A, Pernot M, Albadi W, Taymoor S, Peltan J, Oses P, Barandon L, Bottio T, Gerosa G, Labrousse L. Rapid-deployment aortic valve replacement in high-risk patients with severe endocarditis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:769-775. [PMID: 32558526 DOI: 10.23736/s0021-9509.20.11349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgical management of aortic valve endocarditis in high risk patients is controversial and the ideal treatment has not been found yet. We describe a selected series of eight patients treated with rapid-deployment aortic valve prosthesis as a therapeutic solution for minimizing the risks associated with annulus manipulation in case of severe aortic infective endocarditis. METHODS Eight consecutive patients (five men and three women) with a mean age of 74.3±7.2 years, mean logistic EuroSCORE II of 16.0%±0.1%, affected by aortic native (1 patient), or prosthetic valve endocarditis (7 patients), were treated with Edwards Intuity Elite implantation. Hemodynamic performance and infective data were collected pre-, intra-, and postoperatively with a mean follow-up of 2.7±0.7 years. RESULTS One case of in-hospital mortality was noted. None of the patients had any embolic or infective complication postoperatively. The cardiopulmonary bypass and aortic cross-clamp times were 148.4±41.6 and 90.5±25.3 min, respectively. The postoperative echocardiographic controls indicated a mean transvalvular gradient of 16.7±3.0 mmHg and one case of paravalvular leaks (2 +). Two patients underwent epigastric permanent pacemaker implantation. During the follow-up, seven patients were alive, with no evidence of symptoms or recurrences of endocarditis or embolic episodes. No new paravalvular leaks were noted, and the mean gradient on the valves was 12.4±3.4 mmHg. CONCLUSIONS Rapid deployment aortic valve replacement in selected very high-risk patients affected by infective endocarditis could be a reasonable choice with acceptable results. However, further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Antonio Piperata
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France - .,Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, UCL Namur University Hospital, Catholic University of Louvain, Yvoir, Belgium -
| | - Gregory Kalscheuer
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France.,Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alexandre Metras
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Mathieu Pernot
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Waleed Albadi
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Saud Taymoor
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Julien Peltan
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre Oses
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Laurent Barandon
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Tomaso Bottio
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gino Gerosa
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Louis Labrousse
- Department of Valvulopathies, Cardiac Surgery and Adult Interventional Cardiology, de Haut-Lévèque Hospital, University Hospital of Bordeaux, Bordeaux, France
| |
Collapse
|
14
|
Yang B, Caceres J, Farhat L, Le T, Brown B, St Pierre E, Wu X, Kim KM, Patel HJ, Deeb GM. Root abscess in the setting of infectious endocarditis: Short- and long-term outcomes. J Thorac Cardiovasc Surg 2020; 162:1049-1059.e1. [PMID: 32418636 DOI: 10.1016/j.jtcvs.2019.12.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the influence of an aortic root abscess on perioperative outcomes and long-term survival in patients with active infectious endocarditis that was treated surgically. METHODS From 1996 to 2017, 336 consecutive patients were treated with aortic valve or root replacement for infective endocarditis, including patients with (n = 179) or without (n = 157) a root abscess. Data were obtained from the Society of Thoracic Surgeons data warehouse, through chart review, patient surveys, and National Death Index data. RESULTS Demographic characteristics were similar between groups except the root abscess group had a significantly lower prevalence of congestive heart failure and higher rates of prosthetic valve endocarditis. The abscess group had significantly more aortic root replacements as well as longer cardiopulmonary bypass and crossclamp times. Operative mortality was 8.4% and 3.8% (P = .11) for the abscess and no abscess groups, respectively. Nevertheless, the root-abscess group had prolonged ventilation and longer intensive care unit stays. Kaplan-Meier survival was similar between root abscess and no abscess groups (10-year survival 41% vs 43%; P = .35). Significant risk factors for all-time mortality included age greater than 70 (hazard ratio [HR], 2.85; 95% confidence interval [CI], 1.55, 5.24), the presence of a root abscess (HR, 1.42; 95% CI, 1.02, 1.96), intravenous drug use (HR, 1.81; 95% CI, 1.13, 2.89), congestive heart failure (HR, 1.72; 95% CI, 1.22, 2.42), renal failure requiring dialysis (HR, 3.26; 95% CI, 2.30, 4.64), liver disease (HR, 3.04; 95% CI, 1.65, 5.60), and postoperative sepsis (HR, 3.00; 95% CI, 1.30, 6.93). The 10-year rate of reoperation was also similar between groups (5.9% vs 7.9%). CONCLUSIONS Thorough and extensive debridement is critical for successful treatment of active endocarditis with root abscess. Bioprosthetic stented and stentless valves are valid conduits to treat endocarditis with root abscess.
Collapse
Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
| | - Juan Caceres
- University of Michigan Medical School, Ann Arbor, Mich
| | - Linda Farhat
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Tan Le
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bailey Brown
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Emma St Pierre
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| |
Collapse
|
15
|
Mennander AA. Stepping down from the ivory tower: Inviting the patient for mutual responsibility. J Thorac Cardiovasc Surg 2018; 156:1496-1497. [DOI: 10.1016/j.jtcvs.2018.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
|
16
|
Sultan I, Bianco V, Kilic A, Chu D, Navid F, Gleason TG. Aortic root replacement with cryopreserved homograft for infective endocarditis in the modern North American opioid epidemic. J Thorac Cardiovasc Surg 2018; 157:45-50. [PMID: 30285921 DOI: 10.1016/j.jtcvs.2018.05.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study mid-term survival in patients with infective endocarditis as a result of IV drug use undergoing aortic root replacement with cryopreserved aortic homograft. METHODS Patients undergoing aortic root homograft replacement from 2011-2017 were studied retrospectively. Aortic root replacement was performed using a modified Bentall technique. Primary outcomes included both short-term and mid-term survival. Secondary outcomes included immediate postoperative complications. RESULTS A total of 138 patients underwent cryopreserved homograft replacement of the aortic root for aortic root abscesses. Eighty-five patients (61.6%) underwent reoperative sternotomy, and 12 patients (8.7%) underwent second or third reoperative sternotomy. Sixty-seven (48.5%) patients had severe aortic insufficiency preoperatively. Operative mortality was 12.3% (17 patients). Five patients (3.6%) sustained a permanent stroke. Twenty-one patients (15.2%) required dialysis for renal failure, and 21 patients (15.2%) had complete heart block necessitating a permanent pacemaker. Estimated 5-year mortality for the cohort was 43%. CONCLUSIONS Cryopreserved homograft replacement is a safe and desirable option for high-risk patients with infective endocarditis and aortic root abscess. Homograft accommodation for a widely debrided aortic annular bed provides a reasonable surgical strategy for patients needing aortic root replacement with annular abscess.
Collapse
Affiliation(s)
- Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Valentino Bianco
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa
| |
Collapse
|
17
|
Jacob KA, Suyker WJL. Cardiac surgery in patients with a porcelain aorta. J Thorac Cardiovasc Surg 2018; 155:531-532. [PMID: 29415380 DOI: 10.1016/j.jtcvs.2017.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kirolos A Jacob
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem J L Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
18
|
Mistiaen WP. What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review. SCAND CARDIOVASC J 2018; 52:58-68. [DOI: 10.1080/14017431.2018.1433318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wilhelm P. Mistiaen
- Faculty of Medicine & Health Sciences, Department of Rehabilitation Sciences and Physiotherapy Antwerp, University of Antwerp, Antwerp, Belgium
- Department of Healthcare & Wellbeing, Artesis-Plantijn University College of Antwerp, Antwerp, Belgium
| |
Collapse
|
19
|
Return to the workforce following infective endocarditis-A nationwide cohort study. Am Heart J 2018; 195:130-138. [PMID: 29224640 DOI: 10.1016/j.ahj.2017.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age. METHODS Using Danish nationwide registries, we identified 1,065 patients aged 18-60 years with a first-time diagnosis of IE (1996-2013) who were part of the workforce prior to admission and alive at discharge. RESULTS One year after discharge, 765 (71.8%) patients had returned to the workforce, 130 (12.2%) were on paid sick leave, 76 (7.1%) received disability pension, 23 (2.2%) were on early retirement, 65 (6.1%) had died, and 6 (0.6%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-40 vs 56-60 years; odds ratio, 2.85; 95% CI, 1.71-4.76) and higher level of education (higher educational level vs basic school; 5.47, 2.05-14.6) and income (highest quartile vs lowest; 3.17, 1.85-5.46) were associated with return to the workforce. Longer length of hospital stay (>90 vs 14-30 days; 0.16, 0.07-0.38); stroke during IE admission (0.38, 0.21-0.71); and a history of chronic kidney disease (0.29, 0.11-0.75), chronic obstructive pulmonary disease (0.31, 0.13-0.71), and malignancy (0.39, 0.22-0.69) were associated with a lower likelihood of returning to the workforce. CONCLUSIONS Seven of 10 patients who were part of the workforce prior to IE and alive at discharge were part of the workforce 1 year later. Younger age, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce.
Collapse
|
20
|
Okada K, Inoue Y, Haida H, Suzuki S. Aortic valve reconstruction using autologous pericardium (Ozaki procedure) for active infective endocarditis: a case report. Gen Thorac Cardiovasc Surg 2017; 66:546-548. [DOI: 10.1007/s11748-017-0875-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
|
21
|
Diab M, Sponholz C, von Loeffelholz C, Scheffel P, Bauer M, Kortgen A, Lehmann T, Färber G, Pletz MW, Doenst T. Impact of perioperative liver dysfunction on in-hospital mortality and long-term survival in infective endocarditis patients. Infection 2017; 45:857-866. [DOI: 10.1007/s15010-017-1064-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
|
22
|
Suárez Bagnasco M, Núñez-Gil IJ. Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects. World J Cardiol 2017; 9:620-628. [PMID: 28824792 PMCID: PMC5545146 DOI: 10.4330/wjc.v9.i7.620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/16/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize the current evidence on psychological issues in thoracic aortic disease (TAD) and infective endocarditis (IE) setting.
METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, PubMed and PsycINFO, we searched full manuscripts in English and published until September 1, 2014.
RESULTS We found sixteen studies exploring psychological issues in patients with IE (six studies) and in TAD (ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE (four papers) and in TAD (eight papers). Depression and anxiety were analyzed in TAD only (five papers). Post-traumatic stress disorder was assessed in IE (one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ.
CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
Collapse
|
23
|
Cryopreserved human aortic root allografts arterial wall: Structural changes occurring during thawing. PLoS One 2017; 12:e0175007. [PMID: 28414740 PMCID: PMC5393551 DOI: 10.1371/journal.pone.0175007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background The aim of our experimental work was to assess morphological changes of arterial wall that arise during different thawing protocols of a cryopreserved human aortic root allograft (CHARA) arterial wall. Methods The experiment was performed on CHARAs. Two thawing protocols were tested: 1, CHARAs were thawed at a room temperature at +23°C; 2, CHARAs were placed directly into a water bath at +37°C. Microscopic samples preparation After fixation, all samples were washed in distilled water for 5 min, and dehydrated in a graded ethanol series (70, 85, 95, and 100%) for 5 min at each level. The tissue samples were then immersed in 100% hexamethyldisilazane for 10 minutes and air dried in an exhaust hood at room temperature. Processed samples were mounted on stainless steel stubs, coated with gold. Results Thawing protocol 1: All 6 (100%) samples showed loss of the endothelium and damage to the subendothelial layers with randomly dispersed circular defects and micro-fractures without smooth muscle cells contractions in the tunica media. Thawing protocol 2: All 6 (100%) samples showed loss of endothelium from the luminal surface, longitudinal corrugations in the direction of blood flow caused by smooth muscle cells contractions in the tunica media with frequent fractures in the subendothelial layer Conclusion All the samples thawed at the room temperature showed smaller structural damage to the CHARA arterial wall with no smooth muscle cell contraction in tunica media when compared to the samples thawed in a water bath.
Collapse
|
24
|
Perrotta S, Lentini S. Surgical management of severe damage of the aortic annulus. Hellenic J Cardiol 2017; 57:382-388. [PMID: 28372901 DOI: 10.1016/j.hjc.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/12/2015] [Indexed: 10/20/2022] Open
Abstract
Aortic annular erosion and abscess are serious complications of prosthetic aortic valve endocarditis and can be treated with aortic valve translocation and left ventricle outflow tract reconstruction. These two surgical techniques seem to have similar early postoperative outcomes, and their use can be considered an option after the failure of conventional surgical methods.
Collapse
Affiliation(s)
- Sossio Perrotta
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Salvatore Lentini
- Cardiovascular Department, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
| |
Collapse
|
25
|
Rasmussen TB, Zwisler AD, Thygesen LC, Bundgaard H, Moons P, Berg SK. High readmission rates and mental distress after infective endocarditis - Results from the national population-based CopenHeart IE survey. Int J Cardiol 2017; 235:133-140. [PMID: 28262341 DOI: 10.1016/j.ijcard.2017.02.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a severe disease requiring lengthy hospitalisation. Little is known about patients' recovery after IE. The aims of this study in IE patients were; (i) to describe mortality, readmission, self-reported health and rehabilitation up to 1year post-discharge, (ii) to examine associations between self-reported health and readmission, and (iii) to investigate predictors of readmission and mortality. METHODS All adults treated for IE in Denmark, January-June 2011 (N=347), were followed in registers. Eligible individuals (n=209) were invited to participate in a questionnaire survey (responders n=122). Responses were compared with those of a background reference population and a heart valve surgery population. Mortality and readmission data from registers 12months post-discharge were investigated. RESULTS Patients discharged after treatment for IE had a mortality of 18% (95% confidence interval (CI): 14%-23%) one year post-discharge and 65% (95% CI: 59%-71%) had been readmitted, the majority (82%) acutely. Patients had lower self-reported health compared to the background population (physical component scale (PCS); mean (standard deviation (SD)): 42.2 (11.1) vs. 47.1 (12.1), (p=0.0004), mental component scale (MCS); 50.1 (11.7) vs. 53.8 (9.2), (p=0.006), and more were sedentary (29 vs. 15%), (p=0.002). Large proportions had clinical signs of anxiety and depression, 25% and 22% respectively, exceeding a hospital anxiety and depression scale (HADS) cut-off score of 8. Almost half (47%) had not been offered cardiac rehabilitation (CR). CONCLUSIONS After IE, mortality and readmission rates were high and self-reported physical and mental health poor. These findings call for changes in in-hospital and post-discharge management.
Collapse
Affiliation(s)
- Trine Bernholdt Rasmussen
- The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Department of Cardiology (Section SA-835), Herlev and Gentofte University Hospital, Kildegårdsvej 28, 2900 Hellerup, Denmark.
| | - Ann-Dorthe Zwisler
- National Centre of rehabilitation and palliation, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark.
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark.
| | - Henning Bundgaard
- The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, blok D, box 7001, 3000 Leuven, Belgium; Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens backe 20, 41346 Gothenburg, Sweden.
| | - Selina Kikkenborg Berg
- The Heart Centre (Section 2151), Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| |
Collapse
|
26
|
Koo HJ, Lee HN, Anh TT, Kang JW, Yang DH, Song JK, Kang DH, Song JM, Lee JW, Chung CH, Choo SJ, Lim TH. Postoperative Complications after Surgical Aortic Valve Replacement. ACTA ACUST UNITED AC 2017. [DOI: 10.22468/cvia.2017.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Na Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Tran ThiXuan Anh
- Department of Cardiology, University Medical Center, Ho Chi Minh, Vietnam
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Suk-Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Raman J, Lai DTM, Dobrilovic N, Aziz S. Dacron Skirt Reconstruction of the Left Ventricular Outflow Tract: Extending the Capabilities of a Valved Conduit. Ann Thorac Surg 2016; 103:e97-e99. [PMID: 28007290 DOI: 10.1016/j.athoracsur.2016.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
Abstract
Aortic root reconstruction in the setting of redo aortic valve procedures or infective endocarditis may be technically challenging, particularly because of variable destruction or distortion of the left ventricular outflow tract. Homograft aortic root replacement is an excellent option for aortic root abscesses but is limited by homograft availability. We describe a simple technique of a bioprosthetic valved conduit constructed on the table using a Dacron (DuPont, Wilmington, DE) skirt below the valve. The use of the Dacron skirt facilitates easy reconstruction of the left ventricular outflow tract.
Collapse
Affiliation(s)
- Jai Raman
- Cardiothoracic Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | | | | | - Salim Aziz
- George Washington University Medical Center, Washington DC
| |
Collapse
|
28
|
Does type of prosthesis affect long-term outcomes after aortic valve replacement for infective endocarditis? How should we properly answer this question? J Thorac Cardiovasc Surg 2016; 153:829-830. [PMID: 27993368 DOI: 10.1016/j.jtcvs.2016.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
|
29
|
Valve selection in aortic valve endocarditis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:203-209. [PMID: 27785132 PMCID: PMC5071586 DOI: 10.5114/kitp.2016.62605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/18/2016] [Indexed: 01/19/2023]
Abstract
Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.
Collapse
|
30
|
Abstract
Infective endocarditis (IE) is a rare, life-threatening disease that has long-lasting effects even among patients who survive and are cured. IE disproportionately affects those with underlying structural heart disease and is increasingly associated with health care contact, particularly in patients who have intravascular prosthetic material. In the setting of bacteraemia with a pathogenic organism, an infected vegetation may form as the end result of complex interactions between invading microorganisms and the host immune system. Once established, IE can involve almost any organ system in the body. The diagnosis of IE may be difficult to establish and a strategy that combines clinical, microbiological and echocardiography results has been codified in the modified Duke criteria. In cases of blood culture-negative IE, the diagnosis may be especially challenging, and novel microbiological and imaging techniques have been developed to establish its presence. Once diagnosed, IE is best managed by a multidisciplinary team with expertise in infectious diseases, cardiology and cardiac surgery. Antibiotic prophylaxis for the prevention of IE remains controversial. Efforts to develop a vaccine that targets common bacterial causes of IE are ongoing, but have not yet yielded a commercially available product.
Collapse
Affiliation(s)
- Thomas L Holland
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Room 185 Hanes Building, 315 Trent Drive, Durham, North Carolina 27710, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Larry M Baddour
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arnold S Bayer
- Department of Medicine, David Geffen School of Medicine at UCLA, Torrance, California, USA
| | - Bruno Hoen
- Department of Infectious Diseases, University Hospital of Pointe-Pitre, Pointe-Pitre, France
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vance G Fowler
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Room 185 Hanes Building, 315 Trent Drive, Durham, North Carolina 27710, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
31
|
Solari S, Mastrobuoni S, De Kerchove L, Navarra E, Astarci P, Noirhomme P, Poncelet A, Jashari R, Rubay J, El Khoury G. Over 20 years experience with aortic homograft in aortic valve replacement during acute infective endocarditis. Eur J Cardiothorac Surg 2016; 50:1158-1164. [PMID: 27229671 DOI: 10.1093/ejcts/ezw175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/23/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Despite the controversy, the aortic homograft is supposedly the best option in acute infective endocarditis (AIE), due to its resistance to reinfection. However, the technical complexity and the risk of structural deterioration over time have limited its utilization. The aim of this study was to evaluate the long-term results of aortic homograft for the treatment of infective endocarditis in our institution with particular attention to predictors of survival and homograft reoperation. METHODS The cohort includes 112 patients who underwent aortic valve replacement with an aortic homograft for AIE between January 1990 and December 2014. RESULTS Fifteen patients (13.4%) died during the first 30 days after the operation. Two patients were lost to follow-up after discharge from the hospital; therefore, 95 patients were available for long-term analysis. The median duration of follow-up was 7.8 years (IQR 4.7-17.6). Five patients (5.3%) suffered a recurrence of infective endocarditis (1 relapse and 4 new episodes). Sixteen patients (16.8%) were reoperated for structural valve degeneration (SVD; n = 14, 87.5%) or for infection recurrence (n = 2, 12.5%). Freedom from homograft reoperation for infective endocarditis or structural homograft degeneration at 10 and 15 years postoperatively was 86.3 ± 5.5 and 47.3 ± 11.0%, respectively. For patients requiring homograft reoperation, the median interval to reintervention was 11.6 years (IQR 8.3-14.5). Long-term survival was 63.6% (95% CI 52.4-72.8%) and 53.8% (95% CI 40.6-65.3%) at 10 and 15 years, respectively. CONCLUSIONS The use of aortic homograft in acute aortic valve endocarditis is associated with a remarkably low risk of relapsing infection and very acceptable long-term survival. The risk of reoperation due to SVD is significant after one decade especially in young patients. The aortic homograft seems to be ideally suited for reconstruction of the aortic valve and cardiac structures damaged by the infective process especially in early surgery.
Collapse
Affiliation(s)
- Silvia Solari
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent De Kerchove
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Noirhomme
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alain Poncelet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ramadan Jashari
- European Homograft Bank (EHB), Hôpital Saint-Jean, Brussels, Belgium
| | - Jean Rubay
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium .,Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
32
|
Zacek P, Holubec T, Vobornik M, Dominik J, Takkenberg J, Harrer J, Vojacek J. Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study. BMC Cardiovasc Disord 2016; 16:63. [PMID: 27039180 PMCID: PMC4818911 DOI: 10.1186/s12872-016-0236-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 03/23/2016] [Indexed: 11/21/2022] Open
Abstract
Background In patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the age of the patient), Ross procedure and mechanical aortic valve replacement. Methods Quality of life was studied in 139 patients after aortic valve surgery divided into four study groups (Y – aortic valve-sparing procedure at the age below 50 years, mean age 36.2 years; O – aortic valve-sparing procedure at the age 50 years and over, mean age 59.2 years; R – Ross procedure, mean age 37.8 years and M – mechanical aortic valve replacement at the age below 50 years, mean age 39.2 years). SF-36 Short Form and valve-specific questionnaires were mailed to the patients after 6 months or later following surgery (median 26.9 months). Results In SF-36, the younger aortic valve repair patients and the Ross patients scored significantly better in 4 of 4 physical subscales and in 2 of 4 mental subscales than the older aortic valve repair and mechanical valve replacement patients. In the valve-specific questionnaire; however, all 3 groups free of anticoagulation (Y, O, and R) displayed greater freedom from negative valve-related concerns. Conclusions Postoperative quality of life is influenced by the type of aortic valve procedure and is negatively linked with mechanical prosthesis implantation and long-term anticoagulation. Aortic valve-sparing strategy should be considered in cases with suitable valve morphology due to favorable clinical results and beneficial impact on the long-term quality of life.
Collapse
Affiliation(s)
- Pavel Zacek
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic.
| | - T Holubec
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - M Vobornik
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - J Dominik
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - J Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - J Harrer
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - J Vojacek
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| |
Collapse
|
33
|
Abstract
BACKGROUND Infective endocarditis (IE) is a traumatic health event, and recovery is often associated with massive physical deconditioning and reduced quality of life. Patients also report reduced cognitive functioning and are at risk of developing anxiety and depression as well as posttraumatic stress disorder. Although studies have found that survivors of IE have impaired physical functioning and mental health, little is known about patient experiences contributing to these findings. OBJECTIVE The aim of this study was to describe patient experiences of recovery after IE. SUBJECTS AND METHODS Within a phenomenological-hermeneutical framework, a qualitative interview study was conducted that included 6 men and 5 women (aged 29-86 years). Patients were interviewed 3 to 6 months after discharge. Analysis consisted of 3 levels: naive reading, structured analysis, and critical interpretation and discussion. FINDINGS The overall concept that emerged was "Insufficient Living." Patients all experienced a life after illness, which was perceived as insufficient. The overall concept can be interpreted in terms of the following 3 themes. The first was "an altered life," where participants described a phase of adaptation to a new life situation, which some perceived as manageable and temporary, whereas others found extremely distressing and prolonged. "Shocking weakness" was experienced physically, cognitively, and emotionally, and although it subsided quickly for a few, most experienced a persisting weakness and felt frustrated about the prolonged recovery phase. In "the road to recovery," support from relatives and healthcare professionals, as well as one's own actions, was emphasized as important in facilitating recovery. CONCLUSIONS Recovery after IE is perceived as "Insufficient Living." Patients experience an altered life and shocking weakness, and on the road to recovery, support is needed. Research in follow-up care, supporting patients' ability to cope with potential physical and psycho-emotional consequences of IE, is encouraged as a result of these findings.
Collapse
|
34
|
Kim JB, Ejiofor JI, Yammine M, Camuso JM, Walsh CW, Ando M, Melnitchouk SI, Rawn JD, Leacche M, MacGillivray TE, Cohn LH, Byrne JG, Sundt TM. Are homografts superior to conventional prosthetic valves in the setting of infective endocarditis involving the aortic valve? J Thorac Cardiovasc Surg 2016; 151:1239-46, 1248.e1-2. [PMID: 26936004 DOI: 10.1016/j.jtcvs.2015.12.061] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/25/2015] [Accepted: 12/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical dogma suggests that homografts should be used preferentially, compared with conventional xenograft or mechanical prostheses, in the setting of infective endocarditis (IE), because they have greater resistance to infection. However, comparative data that support this notion are limited. METHODS From the prospective databases of 2 tertiary academic centers, we identified 304 consecutive adult patients (age ≥17 years) who underwent surgery for active IE involving the aortic valve (AV), in the period 2002 to 2014. Short- and long-term outcomes were evaluated using propensity scores and inverse-probability weighting to adjust for selection bias. RESULTS Homografts, and xenograft and mechanical prostheses, were used in 86 (28.3%), 139 (45.7%), and 79 (26.0%) patients, respectively. Homografts were more often used in the setting of prosthetic valve endocarditis (58.1% vs 28.8%, P = .002) and methicillin-resistant Staphylococcus (25.6% vs 12.1%, P = .002), compared with conventional prostheses. Early mortality occurred in 17 (19.8%) in the homograft group, and 20 (9.2%) in the conventional group (P = .019). During follow-up (median: 29.4 months; interquartile-range: 4.7-72.6 months), 60 (19.7%) patients died, and 23 (7.7%) experienced reinfection, with no significant differences in survival (P = .23) or freedom from reinfection rates (P = .65) according to the types of prostheses implanted. After adjustments for baseline characteristics, using propensity-score analyses, use of a homograft did not significantly affect early death (odds ratio 1.61; 95% confidence interval [CI], 0.73-3.40, P = .23), overall death (hazard ratio 1.10; 95% CI, 0.62-1.94, P = .75), or reinfection (hazard ratio 1.04; 95% CI, 0.49-2.18, P = .93). CONCLUSIONS No significant benefit to use of homografts was demonstrable with regard to resistance to reinfection in the setting of IE. The choice among prosthetic options should be based on technical and patient-specific factors. Lack of availability of homografts should not impede appropriate surgical intervention.
Collapse
Affiliation(s)
- Joon Bum Kim
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Maroun Yammine
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Janice M Camuso
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | - Masahiko Ando
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Serguei I Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - James D Rawn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Marzia Leacche
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Thomas E MacGillivray
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Lawrence H Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - John G Byrne
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| |
Collapse
|
35
|
Perrotta S, Jeppsson A, Fröjd V, Svensson G. Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience. Ann Thorac Surg 2015; 101:1426-32. [PMID: 26453420 DOI: 10.1016/j.athoracsur.2015.07.082] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sossio Perrotta
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victoria Fröjd
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Svensson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
36
|
Jarral OA, Kidher E, Patel VM, Nguyen B, Pepper J, Athanasiou T. Quality of life after intervention on the thoracic aorta. Eur J Cardiothorac Surg 2015; 49:369-89. [DOI: 10.1093/ejcts/ezv119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
|
37
|
Jassar AS, Desai ND, Kobrin D, Pochettino A, Vallabhajosyula P, Milewski RK, McCarthy F, Maniaci J, Szeto WY, Bavaria JE. Outcomes of aortic root replacement after previous aortic root replacement: the "true" redo root. Ann Thorac Surg 2015; 99:1601-8; discussion 1608-9. [PMID: 25754965 DOI: 10.1016/j.athoracsur.2014.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aortic reoperations are technically challenging. This study evaluated outcomes after "true" redo root replacement (previous full root replacement) stratified by cause of prosthesis failure. METHODS Data were compared for 793 patients who underwent a first-time sternotomy (de novo group) and 120 patients who had previously undergone full aortic root replacement (redo group), of which 76 underwent reoperation due to structural valve deterioration (degenerative group), and 44 due to endocarditis (infection group). RESULTS Overall mortality was 4% (n = 28) in the de novo group and 5% (n = 6) in the redo group (p = 0.43) (degenerative group, 3%, infection group, 9%; p = 0.19). The infection group had an increased incidence of renal failure, sternal infection, prolonged ventilation, reoperation for bleeding, multisystem failure, and sepsis, and an increased hospital length of stay. The degenerative group and the de novo group had a similar risk of perioperative death and major complications. The 5-year survival was 86.3% ± 1.3% for the de novo group and 77.3% ± 4.6% for the redo group (p ≤ 0.01; degenerative, 86.3% ± 5%; infection, 65.3% ± 7.7%; p < 0.01; p = 0.98 for de novo vs degenerative). Multivariate analysis demonstrated that reoperation for degenerative failure did not increase the risk of perioperative or late death. CONCLUSIONS Redo aortic root replacement can be performed with low perioperative morbidity and death. The presence of infection increases the risk of complications and worsens survival. However, redo root replacement for degenerative failure can be performed with similar short-term complication risk and midterm survival as de novo root replacement.
Collapse
Affiliation(s)
- Arminder S Jassar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dale Kobrin
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alberto Pochettino
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fenton McCarthy
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon Maniaci
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
38
|
Abstract
PURPOSE This study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation. MATERIALS AND METHODS Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50±14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed. RESULTS There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8±11.8 mm to 52.6±8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4±12.0% to 49.8±16.5%, p<0.001). The mean follow-up duration was 68.7±40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2±0.7 to 1.2±0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%. CONCLUSION Surgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.
Collapse
Affiliation(s)
- Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Chul Chang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
39
|
Fukushima S, Tesar PJ, Pearse B, Jalali H, Sparks L, Fraser JF, Pohlner PG. Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft. J Thorac Cardiovasc Surg 2013; 148:65-72.e2. [PMID: 24021951 DOI: 10.1016/j.jtcvs.2013.07.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/04/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the frequency of biological valve use in treating aortic valve disease is increasing, the critical limiting factor, "structural deterioration," remains unresolved. Analysis of long-term outcomes after implantation of cryopreserved aortic allografts will yield further information related to the durability of the aortic allograft, possibly suggesting mechanisms underlying or strategies to prevent or treat the structural deterioration of biological valve substitutes. METHODS A total of 840 cryopreserved aortic allografts implanted in the last 35 years were reviewed with clinical follow-up completed in 99% of the consecutive series. By June 2010, 285 implanted allografts had been surgically explanted, 288 patients died before allograft removal, and 267 patients are under continued follow-up. RESULTS Cryopreserved aortic allografts were durable for more than 15 years in the middle-aged and older patient population. The estimated median time until structural deterioration was 20 years post-implantation, and 2 allografts have been functioning well for more than 30 years. Structural deterioration was independently related to the young age of the recipient, elderly age of the donor, severe obesity in the recipient, history of blood transfusion in the recipient, and full-root implantation technique. Infection of the implanted allograft necessitating reintervention rarely occurred. Reintervention for the allograft demonstrated 2% in-hospital mortality. CONCLUSIONS Cryopreserved aortic allografts were durable for more than 15 years. Structural deterioration of aortic allografts was related to multiple factors. The age of the recipient and the donor, obesity and blood transfusion history of the recipient, and implantation technique were identified as the most important factors contributing to allograft failure.
Collapse
Affiliation(s)
- Satsuki Fukushima
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia.
| | - Peter J Tesar
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - Bronwyn Pearse
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| | - Homayoun Jalali
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia; Queensland Heart Valve Bank, Brisbane, Australia
| | - Lisa Sparks
- Queensland Heart Valve Bank, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, University of Queensland, Brisbane, Australia
| | - Peter G Pohlner
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Australia
| |
Collapse
|
40
|
Valencia Nuñez DM, Merino Cejas C, Alados Arboledas P, Muñoz Carvajal I. Heart transplantation in a patient with recurrent early extensive endocarditis. Interact Cardiovasc Thorac Surg 2013; 17:423-5. [PMID: 23667065 DOI: 10.1093/icvts/ivt195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Active valvular endocarditis could be considered a contraindication to heart transplantation. Nevertheless, there have been some reports of success with this form of treatment, despite the characteristics of the infection and its aggressive nature. Here, we describe the case of a patient with acute bicuspid aortic valvular endocarditis caused by Staphylococcus aureus and with a periannular abscess. Cryopreserved aortic homograft replacement of the aortic root was initially carried out, in addition to debridement and reconstruction of the interventricular septum with a pericardial patch. Early recurrence occurred, however, with extensive tissue destruction, a periaortic abscess and involvement of multiple valves, associated with severe sepsis. In view of the failure of 'conventional' surgery, an emergency heart transplantation was decided on after discussing the case with the Spanish National Transplant Organization (ONT), because of the theoretical contraindication of transplantation in this case. Transplantation was finally carried out after a waiting period of 3 days, in emergency code conditions, and the postoperative course proved uneventful, with no reinfection during the follow-up period. The present case suggests that heart transplantation may be an alternative option in patients suffering aggressive endocarditis with extensive involvement of the heart structures.
Collapse
Affiliation(s)
- Diana M Valencia Nuñez
- Department of Cardiovascular Surgery, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | | | | | | |
Collapse
|
41
|
Neurologic Implications of Critical Illness and Organ Dysfunction. TEXTBOOK OF NEUROINTENSIVE CARE 2013. [PMCID: PMC7119948 DOI: 10.1007/978-1-4471-5226-2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Critical illness has consequences for the nervous system. Patients experiencing critical illness are at risk for common global neurologic disturbances, such as delirium, long-term cognitive dysfunction, ICU-acquired weakness, sleep disturbances, recurrent seizures, and coma. In addition, complications related to specific organ dysfunction may be anticipated. Cardiovascular disease presents the possibility for CNS injury after cardiac arrest, sequelae of endocarditis, aberrancies of blood flow autoregulation, and malperfusion. Respiratory disease is known to cause short-term effects of hypoxia and long-term effects after ARDS. Sepsis encephalopathy and sickness behavior syndrome are early signs of infection in patients. In addition, commonly encountered organ dysfunction including uremia, hepatic failure, endocrine, and metabolic disturbances present with neurologic findings which may manifest in the critically ill patient as well.
Collapse
|
42
|
Lazar HL. The year in review: the surgical treatment of valvular disease-2011. J Card Surg 2012; 27:493-510. [PMID: 22784204 DOI: 10.1111/j.1540-8191.2012.01494.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review highlights important advances in techniques, guidelines, outcomes and innovations in valve surgery during 2011.
Collapse
Affiliation(s)
- Harold L Lazar
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
| |
Collapse
|
43
|
Fagman E, Perrotta S, Bech-Hanssen O, Flinck A, Lamm C, Olaison L, Svensson G. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur Radiol 2012; 22:2407-14. [PMID: 22622348 DOI: 10.1007/s00330-012-2491-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/20/2012] [Accepted: 04/04/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this prospective study was to investigate the agreement in findings between ECG-gated CT and transoesophageal echocardiography (TEE) in patients with aortic prosthetic valve endocarditis (PVE). METHODS Twenty-seven consecutive patients with PVE underwent 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared with surgical findings (surgery was performed in 16 patients). RESULTS TEE suggested the presence of PVE in all patients [thickened aortic wall (n = 17), vegetation (n = 13), abscess (n = 16), valvular dehiscence (n = 10)]. ECG-gated CT was positive in 25 patients (93 %) [thickened aortic wall (n = 19), vegetation (n = 7), abscess (n = 18), valvular dehiscence (n = 7)]. The strength of agreement [kappa (95 % CI)] between ECG-gated CT and TEE was very good for thickened wall [0.83 (0.62-1.0)], good for abscess [0.68 (0.40-0.97)] and dehiscence [0.75 (0.48-1.0)], and moderate for vegetation [0.55 (0.26-0.88)]. The agreement was good between surgical findings (abscess, vegetation and dehiscence) and imaging for ECG-gated CT [0.66 (0.49-0.87)] and TEE [0.79 (0.62-0.96)] and very good for the combination of ECG-gated CT and TEE [0.88 (0.74-1.0)]. CONCLUSION Our results indicate that ECG-gated CT has comparable diagnostic performance to TEE and may be a valuable complement in the preoperative evaluation of patients with aortic PVE.
Collapse
Affiliation(s)
- Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Bruna stråket 11b, 41345, Gothenburg, Sweden.
| | | | | | | | | | | | | |
Collapse
|
44
|
Jassar AS, Bavaria JE, Szeto WY, Moeller PJ, Maniaci J, Milewski RK, Gorman JH, Desai ND, Gorman RC, Pochettino A. Graft Selection for Aortic Root Replacement in Complex Active Endocarditis: Does It Matter? Ann Thorac Surg 2012; 93:480-7. [DOI: 10.1016/j.athoracsur.2011.09.074] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/23/2011] [Accepted: 09/28/2011] [Indexed: 01/09/2023]
|
45
|
Rasmussen TB, Zwisler AD, Sibilitz KL, Risom SS, Bundgaard H, Gluud C, Moons P, Winkel P, Thygesen LC, Hansen JL, Norekvål TM, Berg SK. A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis--the CopenHeartIE trial protocol. BMJ Open 2012; 2:bmjopen-2012-001929. [PMID: 23175738 PMCID: PMC3533051 DOI: 10.1136/bmjopen-2012-001929] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Infective endocarditis (IE) is among the most serious infectious diseases in the western world. Treatment requires lengthy hospitalisation, high-dosage antibiotic therapy and possible valve replacement surgery. Despite advances in treatment, the 1-year mortality remains at 20-40%. Studies indicate that patients experience persisting physical symptoms, diminished quality of life and difficulties returning to work up to a year postdischarge. No studies investigating the effects of rehabilitation have been published. We present the rationale and design of the CopenHeart(IE) trial, which investigates the effect of comprehensive cardiac rehabilitation versus usual care for patients treated for IE. METHODS AND ANALYSIS We will conduct a randomised clinical trial to investigate the effects of comprehensive cardiac rehabilitation versus usual care on the physical and psychosocial functioning of patients treated for IE. The trial is a multicentre, parallel design trial with 1 : 1 individual randomisation to either the intervention or control group. The intervention consists of five psychoeducational consultations provided by specialised nurses and a 12-week exercise training programme. The primary outcome is mental health (MH) measured by the standardised Short Form 36 (SF-36). The secondary outcome is peak oxygen uptake measured by the bicycle ergospirometry test. Furthermore, a number of exploratory analyses will be performed. Based on sample size calculation, 150 patients treated for left-sided (native or prosthetic valve) or cardiac device endocarditis will be included in the trial. A qualitative and a survey-based complementary study will be undertaken, to investigate postdischarge experiences of the patients. A qualitative postintervention study will explore rehabilitation participation experiences. ETHICS AND DISSEMINATION The study complies with the Declaration of Helsinki and was approved by the regional research ethics committee (no H-1-2011-129) and the Danish Data Protection Agency (no 2007-58-0015). Study findings will be disseminated widely through peer-reviewed publications and conference presentations. REGISTRATION Clinicaltrials.gov identifier: NCT01512615.
Collapse
Affiliation(s)
- Trine Bernholdt Rasmussen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - Ann-Dorthe Zwisler
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Signe Stelling Risom
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Philip Moons
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Health Services and Nursing Research, KU Leuven—University of Leuven, Leuven, Belgium
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jane Lindschou Hansen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tone Merete Norekvål
- Haukeland University Hospital, Bergen, Norway
- Institute of Medicine, University of Bergen, Bergen, Norway
| | - Selina Kikkenborg Berg
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | | |
Collapse
|
46
|
Herijgers P. Invited commentary. Ann Thorac Surg 2010; 90:1868. [PMID: 21095328 DOI: 10.1016/j.athoracsur.2010.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 07/11/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Paul Herijgers
- Cardiac Surgery, Katholieke Universiteit Leuven, U. Z. Gasthuisberg, Herestraat 49, Leuven, Belgium B-3000 Germany.
| |
Collapse
|