Surgical treatment of infective aortic valve endocarditis

• Enginoev S.T.
• Ziankou A.A.
• Chernov A.A.
• Hassan M.M.
• Jambieva M.N.
• Ramazanova N.E.
• Bolurova A.M.
• Efremova E.V.
• Kolesnikov V.N.

Abstract

Infective endocarditis (IE) is characterized by an extremely poor prognosis and high mortality. Aortic valve (AV) involvement accounts for about 40–67% of all cases of IE. The study of factors that determine the prognosis of patients with IE AV remains relevant and timely.

Aim. To determine the immediate and long-term results of surgical treatment of IE AV.

Material and methods. The retrospective study included 125 patients [100 men, 25 women, median age 43 (33; 55) years with IE AV], who were operated on from 2009 to 2019 in the Federal Center for Cardiovascular Surgery (Astrakhan). The diagnosis of infective endocarditis was established based on modified Duke ESC 2015 criteria. The median follow-up period was 64 (13–102) months. The primary end point was hospital mortality.

Results. Half of the patients (63; 50.4%) had secondary IE, 14 (11.2%) were diagnosed with acute IE. IE of the native valve was observed in the majority of patients (121; 96.8%), and prosthetic IE – in 4 (3.2%). When assessing long-term results, 18 (14.9%) of 121 patients died. Five- and ten-year survival rates after surgical treatment of patients with IE were 85.6% and 76.1%, respectively. Four patients (3.3%) experienced recurrence of IE in the long-term period. Three patients (2.5%) developed recurrent IE with the development of aortic root abscess. 5- to 10-year freedom from recurrent IE was 96.2% and 96.2%. The majority of patients had a preserved left ventricular ejection fraction [54 (50–58)%] during dynamic echocardiographic monitoring; the peak gradient on the prosthesis or neo-AV was 12 (6–17) mm Hg.

Conclusions. AV IE remains one of the serious problems in cardiology, requiring teamwork and a patient-oriented approach. Further study of predictors of favorable prognosis in this cohort of patients is necessary.

Keywords:acquired heart disease; aortic stenosis; aortic regurgitation; aortic valve; infective endocarditis

References

1.     Thuny F., Grisoli D., Collart F., Habib G., Raoult D. Management of infective endocarditis: challenges and perspectives. Lancet. 2012; 379: 965–75. DOI: https://doi.org/10.1016/S0140-6736(11)60755-1

2.     Habib G. Management of infective endocarditis. Heart. 2006; 92: 124–30. DOI: https://doi.org/10.1136/hrt.2005.063719

3.     Tleyjeh I.M., Steckelberg J.M., Murad H.S., Anavekar N.S., Ghomrawi H.M.K., Mirzoyev Z., et al. Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA. 2005; 293: 3022–8. DOI: https://doi.org/10.1001/jama.293.24.3022

4.     Delgado V., Marsan N.A., de Waha S., et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023; 44 (39): 3948–4042. DOI: https://doi.org/10.1093/eurheartj/ehad193

5.     Nguyen D.T., Delahaye F., Obadia J.-F., Duval X., Selton-Suty C., Carteaux J.-P., et al. Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses. Eur J Cardiothorac Surg. 2010; 37: 1025–32. DOI: https://doi.org/10.1016/j.ejcts.2009.11.035

6.     Habib G., Lancellotti P., Antunes M.J., Bongiorni M.G., Casalta J.-P., Del Zotti F., et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European. Eur Heart J. 2015; 36: 3075–128. DOI: https://doi.org/10.1093/eurheartj/ehv319

7.     Pettersson G.B., Coselli J.S., Pettersson G.B., Coselli J.S., Hussain S.T., Griffin B., et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg. 2017; 153: 1241–58.e29. DOI: https://doi.org/10.1016/j.jtcvs.2016.09.093

8.     Dayer M.J., Prendergast B.D., Thornhill M.H., Baddour L.M. Why are we seeing an increasing incidence of infective endocarditis in the UK? Br J Hosp Med (Lond). 2020; 81: 1–4. DOI: https://doi.org/10.12968/hmed.2020.0263

9.     Nakatani S., Mitsutake K., Ohara T., Kokubo Y., Yamamoto H., Hanai S. Recent picture of infective endocarditis in Japan – lessons from Cardiac Disease Registration (CADRE-IE). Circ J. 2013; 77: 1558–64. DOI: https://doi.org/10.1253/circj.cj-12-1101

10. Zoghbi W.A., Adams D., Bonow R.O., Enriquez-Sarano M., Foster E., Grayburn P.A., et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30: 303–71. DOI: https://doi.org/10.1016/j.echo.2017.01.007

11. Baumgartner H., Hung J., Bermejo J. Chambers J.B., Edvardsen T., Goldstein S., et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017; 30: 372–92. DOI: https://doi.org/10.1016/j.echo.2017.02.009

12. Edwards M.B., Ratnatunga C.P., Dore C.J., Taylor K.M. Thirty-day mortality and long-term survival following surgery for prosthetic endocarditis: a study from the UK heart valve registry. Eur J Cardiothorac Surg. 1998; 14: 156–64. DOI: https://doi.org/10.1016/s1010-7940(98)00148-1

13. Lopes S., Calvinho P., de Oliveira F., Antunes M. Allograft aortic root replacement in complex prosthetic endocarditis. Eur J Cardiothorac Surg. 2007; 32: 122–6. DOI: https://doi.org/10.1016/j.ejcts.2007.01.076

14. Musci M., Weng Y., Hübler M., Amiri A., Pasic M., Kosky S., et al. Homograft aortic root replacement in native or prosthetic active infective endocarditis: twenty-year single-center experience. J Thorac Cardiovasc Surg. 2010; 139: 665–73. DOI: https://doi.org/10.1016/j.jtcvs.2009.07.026

15. Prat A., Fabre O.H., Vincentelli A., Doisy V., Shaaban G. Ross operation and mitral homograft for aortic and tricuspid valve endocarditis. Ann Thorac Surg. 1998; 65: 1450–2. DOI: https://doi.org/10.1016/s0003-4975(98)00100-3

16. Schmidtke C., Dahmen G., Sievers H.-H. Subcoronary Ross procedure in patients with active endocarditis. Ann Thorac Surg. 2007; 83: 36–9. DOI: https://doi.org/10.1016/j.athoracsur.2006.07.066

17. Cabell C.H., Pond K.K., Peterson G.E., Durack D.T., Corey G.R., Anderson D.J., et al. The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J. 2001; 142: 75–80. DOI: https://doi.org/10.1067/mhj.2001.115790

18. Hasbun R., Vikram H.R., Barakat L.A., Buenconsejo J., Quagliarello V.J. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA. 2003; 289: 1933–40. DOI: https://doi.org/10.1001/jama.289.15.1933

19. Lamas C.C., Eykyn S.J. Blood culture negative endocarditis: analysis of 63 cases presenting over 25 years. Heart. 2003; 89: 258–62. DOI: https://doi.org/10.1136/heart.89.3.258

20. Pang P.Y.K., Sin Y.K., Lim C.H., Tan T.E., Lim S.L, Chao V.T.T., et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg. 2015; 47: 826–32. DOI: https://doi.org/10.1093/ejcts/ezu281

21. Delay D., Pellerin M., Carrier M., Marchand R., Auger P., Perrault L.P., et al. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg. 2000; 70: 1219–23. DOI: https://doi.org/10.1016/s0003-4975(00)01887-7

22. Jassal D.S., Neilan T.G., Pradhan A.D., Lynch K.E., Vlahakes G., Agnihotri A.K., et al. Surgical management of infective endocarditis: early predictors of short-term morbidity and mortality. Ann Thorac Surg. 2006; 82: 524–9. DOI: https://doi.org/10.1016/j.athoracsur.2006.02.023

23. Gaca J.G., Sheng S., Daneshmand M.A., O’Brien S., Rankin J.S., Brennan J.M., et al. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg. 2011; 141: 92–8. DOI: https://doi.org/10.1016/j.jtcvs.2010.09.016

24. Prendergast B.D., Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010; 121: 1141–52. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.773598

25. Koeda C., Tashiro A., Itoh T., Okabayashi H., Nakamura M. Mild renal dysfunction on admission is an important prognostic predictor in patients with infective endocarditis: a retrospective single-center study. Intern Med. 2013; 52: 1013–8. DOI: https://doi.org/10.2169/internalmedicine.52.9305

26. Ternhag A., Cederström A., Törner A., Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS One. 2013; 8: e67519. DOI: https://doi.org/10.1371/journal.pone.0067519

27. Elbey M.A., Akdağ S., Kalkan M.E., Kaya M.G., Sayın M.R., Karapınar H., et al. A multicenter study on experience of 13 tertiary hospitals in Turkey in patients with infective endocarditis. Anadolu Kardiyol Derg. 2013; 13: 523–7. DOI: https://doi.org/10.5152/akd.2013.172

28. Chernov I.I., Enginoev S.T., Kondrat’ev D.A., Magomedov G.M., Rashidova T.K, Abdurakhmanov A.A., et al. Ten-year results of the Ross procedure in patients with infective endocarditis: a single-center retrospective study. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2023; 16 (5): 491–7. DOI: https://doi.org/10.17116/kardio202316051491  (in Russian)

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