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Lorenz V, Mastrobuoni S, Aphram G, Pettinari M, de Kerchove L, El Khoury G. Tricuspid valve repair for infective endocarditis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae084. [PMID: 38688562 PMCID: PMC11096269 DOI: 10.1093/icvts/ivae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES The progressive increase in the use of implantable electronic devices, vascular access for dialysis and the increased life expectancy of patients with congenital heart diseases has led in recent years to a considerable number of right-side infective endocarditis, especially of the tricuspid valve (TV). Although current guidelines recommend TV repair for native tricuspid valve endocarditis (TVE), the percentage of valve replacements remains very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE with a reparative approach. METHODS This case series includes all the patients who underwent surgery for acute or healed infective endocarditis on the native TV, at the Cliniques Universitaires Saint-Luc (Bruxelles, Belgium) between February 2001 and December 2020. RESULTS Thirty-one patients were included in the study. Twenty-eight (90.3%) underwent TV repair and 3 (9.7%) had a TV replacement with a mitral homograft. The repair group was divided into 2 subgroups, according to whether a patch was used during surgery or not. Hospital mortality was 33.3% (n = 1) for the replacement group and 7.1% (n = 2) for repair (P = 0.25). Overall survival at 10 years was 75.6% [95% confidence interval (CI): 52-89%]. Further, freedom from reoperation on the TV at 10 years was 59.3% (95% CI: 7.6-89%) vs 93.7% (95% CI: 63-99%) (P = 0.4) for patch repair and no patch use respectively. Freedom from recurrent endocarditis at 10 years was 87% (95% CI: 51-97%). CONCLUSIONS Considering that TVE is more common in young patients, a repair-oriented approach should be considered as the first choice. In the case of extremely damaged valves, the use of pericardial patch is a valid option. If repair is not feasible, the use of a mitral homograft is an additional useful solution to reduce the prosthetic material.
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Affiliation(s)
- Veronica Lorenz
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gaby Aphram
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Matteo Pettinari
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Galeone A, Gardellini J, Perrone F, Francica A, Mazzeo G, Lucchetti MR, Onorati F, Luciani GB. Tricuspid valve repair and replacement for infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:100-109. [PMID: 38827546 PMCID: PMC11139815 DOI: 10.1007/s12055-023-01650-0] [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: 09/13/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis represents a challenging and life-threatening clinical condition affecting native and prosthetic heart valves, endocardium, and implanted cardiac devices. Right-sided infective endocarditis account for approximately 5-10% of all infective endocarditis and are often associated with intravenous drug use, intracardiac devices, central venous catheters, and congenital heart disease. The tricuspid valve is involved in 90% of right-side infective endocarditis. The primary treatment of tricuspid valve infective endocarditis is based on long-term intravenous antibiotics. When surgery is required, different interventions have been proposed, ranging from valvectomy to various types of valve repair to complete replacement of the valve. Percutaneous removal of vegetations using the AngioVac system has also been proposed in these patients. The aim of this narrative review is to provide an overview of the current surgical options and to discuss the results of the different surgical strategies in patients with tricuspid valve infective endocarditis. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01650-0.
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Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Jacopo Gardellini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Fabiola Perrone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Alessandra Francica
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Gina Mazzeo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Marcello Raimondi Lucchetti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy
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Awad AK, Wilson K, Elnagar MA, Elbadawy MA, Fathy MH. To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis. J Cardiothorac Surg 2024; 19:247. [PMID: 38632626 PMCID: PMC11025180 DOI: 10.1186/s13019-024-02767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Valve infective endocarditis (IE) is a potentially life-threatening condition that affects patients' livelihoods. Current surgical options in mitral valve IE include mitral valve repair (MVr) or replacement (MVR). While each procedure boasts its merits, doubt remains as to which type of surgery is superior. METHODS We searched PubMed, Scopus, Web of Science, and Cochrane literature databases for studies comparing MVR and MVr in mitral valve IE. Any randomized controlled trial (RCT) or observational studies that compare MVR vs. MVr in mitral valve IE were eligible. Our dichotomous outcomes were extracted in the form of event and total, and risk and hazard ratio (RR)(HR) with 95% confidence interval (CI) and were pooled and calculated using RevMan 5.0. RESULTS Our study included 23 studies with a total population of 11,802 patients. Compared to MVR, MVr had statistically significant lower risks of both early mortality with RR [0.44; 95% CI, 0.38-0.51; p < 0.001] and long-term follow-up mortality with HR [0.70; 95% CI, 0.58-0.85; p = 0.0004]. Moreover, MVr was associated with a statistically significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32-0.58; p < 0.001]; however, no statistically significant differences between both groups in terms of re-operations with RR [0.83; 95% CI, 0.41-1.67; p = 0.60]. CONCLUSION Our results suggest that MVr was superior in terms of in-hospital mortality, long-term survival, and risk of recurrence without significance in valve reoperation. Therefore, MVr is appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
- Department of Cardiothoracic Surgery, Ain-Shams University Hospitals, Cairo, Egypt
| | - Karim Wilson
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
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Malvindi PG, Luthra S, Zingale A, Bifulco O, Berretta P, Pierri MD, Ohri SK, Di Eusanio M. Surgical repair and replacement for native mitral valve infective endocarditis. J Cardiovasc Med (Hagerstown) 2024; 25:334-341. [PMID: 38407841 DOI: 10.2459/jcm.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
AIMS The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. METHODS Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups. RESULTS Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). CONCLUSIONS Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Anna Zingale
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
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Iaccarino A, Barbone A, Basciu A, Cuko E, Droandi G, Galbiati D, Romano G, Citterio E, Fumero A, Scarfò I, Manzo R, La Canna G, Torracca L. Surgical Challenges in Infective Endocarditis: State of the Art. J Clin Med 2023; 12:5891. [PMID: 37762834 PMCID: PMC10532218 DOI: 10.3390/jcm12185891] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
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Affiliation(s)
- Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessio Basciu
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enea Cuko
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Ginevra Droandi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Denise Galbiati
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Giorgio Romano
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enrico Citterio
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Andrea Fumero
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Iside Scarfò
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Rossella Manzo
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Giovanni La Canna
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
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Luehr M, Weber C, Misfeld M, Lichtenberg A, Tugtekin SM, Diab M, Saha S, Li Y, Matsche K, Doenst T, Borger MA, Wahlers T, Akhyari P, Hagl C. Virulence of Staphylococcus Infection in Surgically Treated Patients With Endocarditis : A Multicenter Analysis. Ann Surg 2023; 277:e1364-e1372. [PMID: 35801702 DOI: 10.1097/sla.0000000000005448] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infective endocarditis (IE) caused by Staphylococcus species (spp.) is believed to be associated with higher morbidity and mortality rates. We hypothesize that Staphylococcus spp. are more virulent compared with other commonly causative bacteria of IE with regard to short-term and long-term mortality. BACKGROUND It remains unclear if patients suffering from IE due to Staphylococcus spp. should be referred for surgical treatment earlier than other IE patients to avoid septic embolism and to optimize perioperative outcomes. MATERIALS AND METHODS The database of the CAMPAIGN registry, comprising 4917 consecutive patients undergoing heart valve surgery, was retrospectively analyzed. Patients were divided into 2 groups with regard to the identified microorganisms: Staphylococcus group and the non- Staphylococcus group. The non- Staphylococcus group was subdivided for further analyses: Streptococcus group, Enterococcus group, and all other bacteria groups. RESULTS The respective mortality rates at 30 days (18.7% vs 11.8%; P <0.001), 1 year (24.7% vs 17.7%; P <0.001), and 5 years (32.2% vs 24.5%; P <0.001) were significantly higher in Staphylococcus patients (n=1260) compared with the non- Staphylococcus group (n=1787). Multivariate regression identified left ventricular ejection fraction <30% ( P <0.001), chronic obstructive pulmonary disease ( P =0.045), renal insufficiency ( P =0.002), Staphylococcus spp. ( P =0.032), and Streptococcus spp. ( P =0.013) as independent risk factors for 30-day mortality. Independent risk factors for 1-year mortality were identified as: age ( P <0.001), female sex ( P =0.018), diabetes ( P =0.018), preoperative stroke ( P =0.039), chronic obstructive pulmonary disease ( P =0.001), preoperative dialysis ( P <0.001), and valve vegetations ( P =0.004). CONCLUSIONS Staphylococcus endocarditis is associated with an almost twice as high 30-day mortality and significantly inferior long-term outcome compared with IE by other commonly causative bacteria. Patients with Staphylococcus infection are more often female and critically ill, with >50% of these patients suffering from clinically relevant septic embolism. Early diagnosis and referral to a specialized center for surgical treatment are strongly recommended to reduce the incidence of preoperative deterioration and stroke due to septic embolism.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Institute of Academic Surgery, RPAH, Sydney, NSW, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Mahmoud Diab
- Department of Cardiac Surgery, University Hospital, University of Jena, Jena, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ
| | - Klaus Matsche
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Torsten Doenst
- Department of Cardiac Surgery, University Hospital, University of Jena, Jena, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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Mennander AA. Commentary: The Role of the Mitral Specialist During and After Endocarditis. Semin Thorac Cardiovasc Surg 2021; 34:78-79. [PMID: 34004304 DOI: 10.1053/j.semtcvs.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/28/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Ari A Mennander
- From Tampere University Heart Hospital and Tampere University, Tampere Finland.
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