OBJECTIVES: We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design. METHODS: Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study. RESULTS: Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P < 0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective. CONCLUSIONS: PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.
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|Titolo:||Surgery for prosthetic valve endocarditis: a retrospective study of a national registry†.|
|Data di pubblicazione:||2017|
|Citazione:||Surgery for prosthetic valve endocarditis: a retrospective study of a national registry†. / Della Corte, A; Di Mauro, M; Actis Dato, G; Barili, F; Cugola, D; Gelsomino, S; Santè, P; Carozza, A; Della Ratta, E; Galletti, L; Devotini, R; Casabona, R; Santini, F; Salsano, A; Scrofani, R; Antona, C; De Vincentiis, C; Biondi, A; Beghi, C; Cappabianca, G; De Bonis, M; Pozzoli, A; Nicolini, F; Benassi, F; Pacini, D; Di Bartolomeo, R; De Martino, A; Bortolotti, U; Lorusso, R; Vizzardi, E; Di Giammarco, G; Marinelli, D; Villa, E; Troise, G; Paparella, D; Margari, V; Tritto, F; Damiani, G; Scrascia, G; Zaccaria, S; Renzulli, A; Serraino, G; Mariscalco, G; Maselli, D; Parolari, A; Nappi, G.. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - (2017).|
|Appare nelle tipologie:||1.1 Articolo in rivista|