title: Periannular complications in infective endocarditis involving prosthetic aortic valves.
abstract: The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinctive clinical characteristics of patients with PVE and either aortocavitary fistulization or nonruptured abscesses. In a retrospective multicenter study of >872 PVE episodes, 150 patients (17%) with periannular complications in PVE in the aortic position were identified (29 with aortocavitary fistulization and 121 with nonruptured abscesses). Early-onset PVE was present in 73 patients (49%). Rates of heart failure (p = 0.09), ventricular septal defect (p <0.01), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 128 patients (83%). In-hospital mortality in the overall population was 39%. Multivariate analysis identified heart failure (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6 to 6.8), renal failure (OR 2.5, 95% CI 1.2 to 5.2), and co-morbidity (OR 2.4, 95% CI 1.1 to 5.1) as independent risk factors for death. Fistulous tract formation was not associated with increased in-hospital mortality (OR 1.6, 95% CI 0.7 to 3.7). The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality.
authors.affiliation: Corporacio Sanitaria Parc Tauli-Hospital de Sabadell, Sabadell, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Anguera
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Jose Alberto
authors.initials: JA
authors.lastname: San Roman
authors.forename: Aristides
authors.initials: A
authors.lastname: de Alarcon
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Tomas
authors.initials: T
authors.lastname: Ripoll
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Enrique
authors.initials: E
authors.lastname: Navas
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez-Juanatey
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarria
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garcia-Bolao
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rufi
authors.forename: Francisco
authors.initials: F
authors.lastname: Miralles
authors.forename: Carles
authors.initials: C
authors.lastname: Pare
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Mestres
authors.forename: Elisa
authors.initials: E
authors.lastname: de Lazzari
authors.forename: Joan R
authors.initials: JR
authors.lastname: Guma
authors.forename: Ana
authors.initials: A
authors.lastname: del Río
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016157:Vascular Fistula / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
chemical_list: D000890:Anti-Infective Agents