Risk of recurrence after reoperation for prosthetic valve endocarditis.
Reoperation after a surgical procedure for prosthetic valve endocarditis (PVE) is often required due to the existence of either septic recurrence or sterile para-prosthetic leak (PL). The aim of this study was to assess the risk to patients of undergoing a second operation after PVE. Thirty-six patients underwent operation for active PVE at our institution. The operative mortality rate was 11.2%. Among the 32 patients discharged, six underwent a second operation (in two cases due to persisting sepsis) and two underwent a third procedure. Multivariate analysis demonstrated increased probability of further operation for: inability to identify the infecting organism (p = 0.005); drug addiction (p = 0.007); existence of annular abscess (p = 0.016); and early occurrence of PVE (p = 0.018). In the case of mechanical prostheses, PVE was not an independent risk factor (p = 0.206). Nonetheless, 58.3% of patients with mechanical prostheses compared with 5.3% of those with bioprostheses showed annular abscesses, while 41.7% of the former versus 5.6% of the latter suffered one or more recurrences.
Pansini
S
S
Department of Cardiac Surgery, University of Turin Medical School, Italy.
di Summa
M
M
Patane
F
F
Forsennati
P G
PG
Serra
M
M
Del Ponte
S
S
D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome