Survival and Quality of Life after Cardiac Reoperations for Replacement of Infected Prosthetic Material

Introduction: The contemporary risk and long-term outcomes of reoperation for replacement of infected prosthetic material are not well known. The aim of our study was to quantify the short-term progression in terms of early death and to describe the long-term trend by means of the current quality of life.

Methods: In the period from January 2012 to December 2016 all operated patients were retrospectively screened for reoperations due to infected prosthetic material (heart valves, annuloplasty rings or conduits). Sixty-seven patients were included in the study. There were 14 women and 53 men, with a mean age of 64 years. The quality of life in terms of physical and mental well-being was assessed using the Short-Form 12 Health Survey. Study population was characterized as follows: 48 cases of isolated aortic valve surgery, 8 cases of mitral valve surgery, 11 cases of combined valve surgery.

Results: Thirty-five patients were initially operated in our Department, resulting in an infection rate of 1.32% for prosthetic material implanted during the study period in our center. The other patients had previous surgery in other centers. Early lethality (30 days) was 17.9% with multiorgan failure and acute heart failure being the main causes of death (34% each). Staphylococci (31%) followed by enterococci (16%) were the most frequent causative microorganisms. In 7% of the cases no microorganisms could be isolated from blood cultures or the explanted prostheses. Thirty-five patients (63% of long term survivors) were alive at the time of data evaluation. Mean follow up time was 22.84 ± 20.83 months. The survey on the current state of physical/mental health shows a 13.2%/6.67% lower mean than the German standard sample.

Conclusion: Replacement of infected prosthetic material remains a cardiac operation with significantly increased mortality. However quality of life seems to be acceptable in survivors, especially with view to the poor therapeutic alternatives.