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Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension

Received: 8 November 2016     Accepted: 24 March 2017     Published: 12 April 2017
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Abstract

Infective endocarditis (IE) is a rare but potentially fatal complication of valve replacement, especially if it is accompanied by periannular extension. In these cases surgical intervention is recommended by consensus and clinical guidelines. However, surgery is frequently delayed or not performed, and the best timing for intervention is still controversial. The aim of this study is to analyze determinants of early surgery of patients with prosthetic valve endocarditis (PVE) with periannular extension (PVEPE) and the influence of timing for surgery in morbidity and mortality in a real clinical scenario. Retrospective analysis of a prospective database registry including 180 consecutive patients with definite diagnosis of endocarditis according to modified Duke`s criteria, admitted between 6/2008 and 1/2016, showed 88 patients (49%) with PVE, 48 (54.5%) of them had periannular extension. The patients with PVEPE were divided in 3 groups according to timing for surgery after admission: GA (17p; <10 days), GB (15p; >10 days) and GC (16p; only medical treatment). We analyzed demographic, clinical, microbiological and echocardiographic variables and we related the treatment strategy selected with in-hospital evolution. Comparing the 3 different groups, we observed that the patients in GA were significantly younger, with a higher frequency of male gender and Staphylococcus spp was significantly the most common microorganism; they had less postoperative complications (64% vs 100%, p: 0.019) and a trend to lower in-hospital mortality (18% vs 46%; p= 0,07). In conclusion, younger male patients with staphylococci PVEPE underwent surgery earlier. This strategy was associated with less anatomical damage and less incidence of postoperative complications with a trend to lower in-hospital mortality.

Published in Advances in Surgical Sciences (Volume 4, Issue 6)
DOI 10.11648/j.ass.20160406.11
Page(s) 26-32
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Prosthetic Valve Endocarditis, Endocarditis, Periannular Extension, Early Surgery, Echocardiography

References
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Cite This Article
  • APA Style

    Mariana Mahia, Ricardo Ronderos, Ana Iribarren, Francisco Nacinovich, Pablo Fernandez Oses, et al. (2017). Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension. Advances in Surgical Sciences, 4(6), 26-32. https://doi.org/10.11648/j.ass.20160406.11

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    ACS Style

    Mariana Mahia; Ricardo Ronderos; Ana Iribarren; Francisco Nacinovich; Pablo Fernandez Oses, et al. Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension. Adv. Surg. Sci. 2017, 4(6), 26-32. doi: 10.11648/j.ass.20160406.11

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    AMA Style

    Mariana Mahia, Ricardo Ronderos, Ana Iribarren, Francisco Nacinovich, Pablo Fernandez Oses, et al. Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension. Adv Surg Sci. 2017;4(6):26-32. doi: 10.11648/j.ass.20160406.11

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  • @article{10.11648/j.ass.20160406.11,
      author = {Mariana Mahia and Ricardo Ronderos and Ana Iribarren and Francisco Nacinovich and Pablo Fernandez Oses and Mariano Vrancic and Martín Vivas and Laura Juarez and Silvana Resi and Eduardo Filipini and Gustavo Avegliano and Fernando Piccinini and Daniel Navia},
      title = {Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension},
      journal = {Advances in Surgical Sciences},
      volume = {4},
      number = {6},
      pages = {26-32},
      doi = {10.11648/j.ass.20160406.11},
      url = {https://doi.org/10.11648/j.ass.20160406.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20160406.11},
      abstract = {Infective endocarditis (IE) is a rare but potentially fatal complication of valve replacement, especially if it is accompanied by periannular extension. In these cases surgical intervention is recommended by consensus and clinical guidelines. However, surgery is frequently delayed or not performed, and the best timing for intervention is still controversial. The aim of this study is to analyze determinants of early surgery of patients with prosthetic valve endocarditis (PVE) with periannular extension (PVEPE) and the influence of timing for surgery in morbidity and mortality in a real clinical scenario. Retrospective analysis of a prospective database registry including 180 consecutive patients with definite diagnosis of endocarditis according to modified Duke`s criteria, admitted between 6/2008 and 1/2016, showed 88 patients (49%) with PVE, 48 (54.5%) of them had periannular extension. The patients with PVEPE were divided in 3 groups according to timing for surgery after admission: GA (17p; 10 days) and GC (16p; only medical treatment). We analyzed demographic, clinical, microbiological and echocardiographic variables and we related the treatment strategy selected with in-hospital evolution. Comparing the 3 different groups, we observed that the patients in GA were significantly younger, with a higher frequency of male gender and Staphylococcus spp was significantly the most common microorganism; they had less postoperative complications (64% vs 100%, p: 0.019) and a trend to lower in-hospital mortality (18% vs 46%; p= 0,07). In conclusion, younger male patients with staphylococci PVEPE underwent surgery earlier. This strategy was associated with less anatomical damage and less incidence of postoperative complications with a trend to lower in-hospital mortality.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension
    AU  - Mariana Mahia
    AU  - Ricardo Ronderos
    AU  - Ana Iribarren
    AU  - Francisco Nacinovich
    AU  - Pablo Fernandez Oses
    AU  - Mariano Vrancic
    AU  - Martín Vivas
    AU  - Laura Juarez
    AU  - Silvana Resi
    AU  - Eduardo Filipini
    AU  - Gustavo Avegliano
    AU  - Fernando Piccinini
    AU  - Daniel Navia
    Y1  - 2017/04/12
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    N1  - https://doi.org/10.11648/j.ass.20160406.11
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    T2  - Advances in Surgical Sciences
    JF  - Advances in Surgical Sciences
    JO  - Advances in Surgical Sciences
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    EP  - 32
    PB  - Science Publishing Group
    SN  - 2376-6182
    UR  - https://doi.org/10.11648/j.ass.20160406.11
    AB  - Infective endocarditis (IE) is a rare but potentially fatal complication of valve replacement, especially if it is accompanied by periannular extension. In these cases surgical intervention is recommended by consensus and clinical guidelines. However, surgery is frequently delayed or not performed, and the best timing for intervention is still controversial. The aim of this study is to analyze determinants of early surgery of patients with prosthetic valve endocarditis (PVE) with periannular extension (PVEPE) and the influence of timing for surgery in morbidity and mortality in a real clinical scenario. Retrospective analysis of a prospective database registry including 180 consecutive patients with definite diagnosis of endocarditis according to modified Duke`s criteria, admitted between 6/2008 and 1/2016, showed 88 patients (49%) with PVE, 48 (54.5%) of them had periannular extension. The patients with PVEPE were divided in 3 groups according to timing for surgery after admission: GA (17p; 10 days) and GC (16p; only medical treatment). We analyzed demographic, clinical, microbiological and echocardiographic variables and we related the treatment strategy selected with in-hospital evolution. Comparing the 3 different groups, we observed that the patients in GA were significantly younger, with a higher frequency of male gender and Staphylococcus spp was significantly the most common microorganism; they had less postoperative complications (64% vs 100%, p: 0.019) and a trend to lower in-hospital mortality (18% vs 46%; p= 0,07). In conclusion, younger male patients with staphylococci PVEPE underwent surgery earlier. This strategy was associated with less anatomical damage and less incidence of postoperative complications with a trend to lower in-hospital mortality.
    VL  - 4
    IS  - 6
    ER  - 

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Author Information
  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiac Imaging Service, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Infectology Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Infectology Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiovascular Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

  • Cardiology Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

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