Difference in Outcome Following Surgery for Native Aortic and Mitral Valve Infective Endocarditis

Abstract

Background We investigated differences in clinical presentation, microbiology, and short- and long-term results according to the affected valve in patients who underwent surgery for left-sided native valve infective endocarditis (IE).

Methods This was a single-center retrospective study of 117 patients with isolated mitral valve IE (group M) and 140 patients with isolated aortic valve IE (group A) who underwent surgery between 1998 and 2015.

Results The mean age of patients in group M was 62 ± 14 years, whereas in group A the patients were 56 ± 14 years old (p = 0.001). There were 61 females (52% of patients) in group M and 31 females (22% of patients) in group A (p < 0.001). Abscesses were more common in group A than in group B. Staphylococcus aureus was more frequent in group M (47%, n = 55) than in group A (21%, n = 30; p < 0.001). The length of time from symptom onset to surgery was longer in group A than in group M, but the time from diagnosis to surgery was shorter in group A than in group M. Ninety-day mortality was similar in group M and group A in patients operated within 48 hours after diagnosis, but in patients who were operated more than 48 hours after diagnosis the 90-day mortality was 15% in group M and 3% in group A (p = 0.006).

Conclusion There were considerable differences in preoperative characteristics, microbiology, timing of surgery, and outcomes between patients who underwent surgery for isolated aortic valve IE and those who were operated for isolated mitral valve IE.

Keywords

endocarditis - heart valve surgery - outcomes - mortality - morbidity

• References

• 1 Cabell CH, Abrutyn E, Fowler Jr VG. , et al; International Collaboration on Endocarditis Merged Database (ICE-MD) Study Group Investigators. Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database. Am Heart J 2005; 150 (05) 1092-1098
• 2 Thuny F, Di Salvo G, Belliard O. , et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005; 112 (01) 69-75
• 3 Mourvillier B, Trouillet J-LL, Timsit J-FF. , et al. Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med 2004; 30 (11) 2046-2052
• 4 Tornos P, Iung B, Permanyer-Miralda G. , et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005; 91 (05) 571-575
• 5 Meszaros K, Nujic S, Sodeck GH. , et al. Long-term results after operations for active infective endocarditis in native and prosthetic valves. Ann Thorac Surg 2012; 94 (04) 1204-1210
• 6 Manne MB, Shrestha NK, Lytle BW. , et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012; 93 (02) 489-493
• 7 Ohara T, Nakatani S, Kokubo Y, Yamamoto H, Mitsutake K, Hanai S. ; CADRE investigators. Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nation-wide survey in Japan. Int J Cardiol 2013; 167 (06) 2688-2694
• 8 Funakoshi S, Kaji S, Yamamuro A. , et al. Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg 2011; 142 (04) 836-842.e1
• 9 San Román JA, Vilacosta I, López J. , et al. Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: one echocardiographic modality does not fit all. J Am Soc Echocardiogr 2012; 25 (08) 807-814
• 10 Cabell CH, Pond KK, Peterson GE. , et al. The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001; 142 (01) 75-80
• 11 Murdoch DR, Corey GR, Hoen B. , et al; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009; 169 (05) 463-473
• 12 Li JS, Sexton DJ, Mick N. , et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30 (04) 633-638
• 13 Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA 2003; 289 (15) 1933-1940
• 14 López J, Revilla A, Vilacosta I. , et al. Age-dependent profile of left-sided infective endocarditis: a 3-center experience. Circulation 2010; 121 (07) 892-897
• 15 Fowler Jr VG, Miro JM, Hoen B. , et al; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293 (24) 3012-3021
• 16 Hussain ST, Shrestha NK, Witten J. , et al. Rarity of invasiveness in right-sided infective endocarditis. J Thorac Cardiovasc Surg 2018; 155 (01) 54-61.e1
• 17 Frater RWM. Surgery for Bacterial Endocarditis. Glenn's Thoracic and Cardiovascular Surgery. East Norwalk, CT: Appleton and Lange; 1996: 1915-1930
• 18 Moreillon P, Que YA. Infective endocarditis. Lancet 2004; 363 (9403): 139-149
• 19 Evans CF, Gammie JS. Surgical management of mitral valve infective endocarditis. Semin Thorac Cardiovasc Surg 2011; 23 (03) 232-240
• 20 Kang DH, Kim YJ, Kim SH. , et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012; 366 (26) 2466-2473
• 21 Misfeld M, Girrbach F, Etz CD. , et al. Surgery for infective endocarditis complicated by cerebral embolism: a consecutive series of 375 patients. J Thorac Cardiovasc Surg 2014; 147 (06) 1837-1844