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Salsano A, Di Mauro M, Labate L, Della Corte A, Lo Presti F, De Bonis M, Trumello C, Rinaldi M, Cura Stura E, Actis Dato G, Punta G, Nicolini F, Carino D, De Vincentiis C, Garatti A, Cappabianca G, Musazzi A, Cugola D, Merlo M, Pacini D, Folesani G, Sponga S, Vendramin I, Pilozzi Casado A, Rosato F, Mikus E, Savini C, Onorati F, Luciani GB, Scrofani R, Epifani F, Musumeci F, Lio A, Colli A, Falcetta G, Nicolardi S, Zaccaria S, Vizzardi E, Pantaleo A, Minniti G, Villa E, Dalla Tomba M, Pollari F, Barili F, Parolari A, Lorusso R, Santini F. Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry. J Clin Med 2023; 13:153. [PMID: 38202159 PMCID: PMC10779833 DOI: 10.3390/jcm13010153] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. METHODS This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. RESULTS Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). CONCLUSIONS The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
| | - Michele Di Mauro
- CARIM Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Laura Labate
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy;
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, 16132 Genoa, Italy
| | - Alessandro Della Corte
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Federica Lo Presti
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Michele De Bonis
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Cinzia Trumello
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | - Erik Cura Stura
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | | | - Giuseppe Punta
- Cardiac Surgery, Mauriziano Hospital, 10128 Turin, Italy; (G.A.D.); (G.P.)
| | - Francesco Nicolini
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Davide Carino
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Carlo De Vincentiis
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | - Andrea Garatti
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | | | - Andrea Musazzi
- Cardiac Surgery, University Hospital, 21100 Varese, Italy; (G.C.); (A.M.)
| | - Diego Cugola
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Maurizio Merlo
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Davide Pacini
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Gianluca Folesani
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Sandro Sponga
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | - Igor Vendramin
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | | | - Francesco Rosato
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Elisa Mikus
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Carlo Savini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Francesco Onorati
- Cardiac Surgery, University Hospital, University of Verona, 37129 Verona, Italy; (F.O.); (G.B.L.)
| | | | - Roberto Scrofani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Epifani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Musumeci
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Antonio Lio
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Andrea Colli
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | - Giosuè Falcetta
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | | | - Salvatore Zaccaria
- Cardiac Surgery, Vito Fazzi Hospital, 73100 Lecce, Italy; (S.N.); (S.Z.)
| | | | - Antonio Pantaleo
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Giuseppe Minniti
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Margherita Dalla Tomba
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg–Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Fabio Barili
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Alessandro Parolari
- Department of Universitary Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, 20122 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
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Formica F, Maestri F, Gripshi F, Gallingani A, Grossi S, Nicolini F. Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10194356. [PMID: 34640374 PMCID: PMC8509294 DOI: 10.3390/jcm10194356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; p < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; p = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
- Correspondence: (F.F.); (F.N.)
| | - Francesco Maestri
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Florida Gripshi
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43126 Parma, Italy;
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, 43126 Parma, Italy; (F.M.); (F.G.); (A.G.)
- Correspondence: (F.F.); (F.N.)
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