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DOI: 10.1055/s-0035-1544463
Outcomes of Surgery for Prosthetic Valve Endocarditis after Stentless Aortic Valve Replacement
Objectives: This study examined the outcomes of surgery for active prosthetic valve endocarditis (PVE) after aortic valve replacement with emphasis on prior stentless prostheses.
Methods: From 2000 to 2013, 104 consecutive patients (age 65 ± 12.7 years, 89 male) underwent redo aortic valve surgery for PVE of 62 stentless valves and 42 prostheses with sewing ring (13 conventional stented bioprostheses, 29 mechanical valves). Early (≤1 year) and late (>1 year) PVE was present in 39 (37.5%) and 65 (62.5%) patients. Staphylococci species were the most common microorganisms (19.2%), but 42 cases (40.4%) were culture-negative. Mean follow-up was 4.9 ± 5.0 years.
Results: Heart failure NYHA≥III (41 [67.2%] versus 17 [41.5%], p = 0.01), early PVE (28 [45.2%] versus 11 [26.2%], p = 0.05), and need for mechanical circulatory support (8 [13.6%] versus 1 [2.4%], p = 0.05) were more frequent in patients with prior stentless aortic prostheses. In total, 15 patients died early after surgery (30-days mortality 14.4%). Various subgroups exhibited increased operative mortalities (Table 1), whereas age, early PVE, Staphylococci species, culture-negative PVE, locally uncontrolled infection, recent thromboembolic events, and urgency did not.
Variable |
n |
Operative mortality |
p |
1-year survival |
p |
---|---|---|---|---|---|
prior stentless prosthesis |
62 |
19.4% |
0.096 |
76.4 ± 5.6% |
0.388 |
preop. shock |
10 |
60.0% |
< 0.001 |
40.0 ± 15.5% |
< 0.001 |
preop. mechanical ventilation |
13 |
53.8% |
< 0.001 |
42.3 ± 14.3% |
< 0.001 |
preop. renal failure |
14 |
50.0% |
0.001 |
41.7 ± 13.5% |
< 0.001 |
LVEF < 40% |
10 |
40.0% |
0.036 |
60.0 ± 15.5% |
0.067 |
heart failure NYHA ≥ III |
59 |
22.0% |
0.012 |
75.1 ± 5.8% |
0.194 |
Overall survival at 1 and 5 years was 80.4 ± 4.1% and 77.1 ± 4.5%, independent of prior stentless or sewing ring prostheses (log rank p = 0.388).
Conclusion: Preoperative sequelae (shock, mechanical ventilation, renal failure) and left ventricular dysfunction above all impaired survival after surgery for aortic valve PVE, essentially due to high early mortality. Prior stentless prostheses, although more frequently associated with heart failure, early PVE, and need for mechanical circulatory support, did not impair 1-year survival, but potentially contributed to increased early mortality.