Surgical Treatment for Active Infective Prosthetic Valve ‎Endocarditis: A Single-Center Experience‎

Objectives: Active infective endocarditis (IE) is a serious disease and still associated with high mortality. Various studies identified the risk factors of surgical interventions for IE. The current study represents our experience over 18 years with surgical treatment for active infective prosthetic valve endocarditis (IPVE).

Methods: The retrospective study included 413 consecutive patients who underwent cardiac surgery due to IE between January 2002 and February 2020 and 171 (41%) of them for IPVE. Perioperative characteristics, risk factors, intraoperative data and predictors for mortality were analyzed. Univariate and multivariable analyses were conducted.

Result: Analysis of the demographic and preoperative status showed that patient with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; p < 0.001) with higher EuroSCORE II [21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); p < 0.001)] and suffered more significantly from coronary heart disease (50.6% vs. 38.0%; p < 0.011).

Preoperative embolization was significantly higher among those patients with no history of cardiac surgery (35.5% vs. 16.4%; p < 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; p < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs. 15.7%; p < 0.001).

Intraoperatively, the length of surgery was expectedly significantly higher in the IPVE group (356 vs. 244 minutes; p = 0.001) as well as transfusion of blood conserves 4 (0–27) versus 2 (0–14); p < 0.001.

Postoperatively, the incidence of bleeding was markedly higher in the IPVE group (700 [438; 1,163] vs. 500 [250; 1,075]: p = 0.005). Patients in the IPVE group required significantly more pacemaker (17.6 vs. 7.5%: p = 0.002). 30-day mortality was also higher in the IPVE group (24.6 vs. 13.2%; p < 0.003).

Conclusion: Patients with active infective prosthetic valve endocarditis were represented commonly with intracardiac abscess, and had higher indication of pacemaker implantation. The mortality rate among those patients was still high. However, patients with IE of native valve suffered from more incidences of embolization and stroke and required emergency surgery.

Publication History

Article published online:
19 February 2021