Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement.
OBJECTIVE
We compared early results of homograft aortic root replacement (ARR) in native (NVE) and prosthetic (PVE) aortic valve endocarditis in order to identify predictors for early mortality (<30 days).


METHODS
Between 05/1986 and 12/2007, 1,163 endocarditis patients were operated upon. Of these, 221 patients (n = 185 men, median age 55 years) underwent homograft ARR due to 99 cases of NVE (45%) and 122 of PVE (55%) aortic root endocarditis. Demographics, clinical differences, survival rates and predictors of early mortality were analyzed. Follow-up (mean 5.2 +/- 0.4 years, maximum 18.4 years) was completed in 96.8% with a total of 1,127 patient years.


RESULTS
Main causes of the 47 (21.2%) early deaths were septic multiorgan failure in 23 (48.9%) and myocardial failure in 10 (21.3%) patients with a significantly better survival for NVE than for PVE patients (patients = 0.029). The highest ORs were found in the univariate analysis for preoperative development of septic shock (OR 14.28), preoperative necessity of ventilation (OR 7.08), high doses of catecholamines (OR 5.60), severe aortic root destruction (OR 5.12), emergency operation (OR 4.25) and persistent fever despite antibiotic treatment (OR 4.11). Multivariate analysis showed that preoperative ventilation (OR 5.43), persistent fever under antibiotic treatment (OR 2.84) and prosthetic endocarditis (OR 2.32) were independent risk factors for early mortality.


CONCLUSIONS
Our results suggest that early outcome could be improved if patients were referred earlier for surgery. A multidisciplinary approach is necessary, involving at least specialists in intensive care medicine, cardiology, infectious disease and cardiac surgery in order to identify the optimal time for surgery and decrease early mortality.
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. musci@dhzb.de
Michele
M
Musci
Yuguo
Y
Weng
Michael
M
Hübler
Tito
T
Chavez
Naser
N
Qedra
Susanne
S
Kosky
Julia
J
Stein
Henryk
H
Siniawski
Roland
R
Hetzer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001424:Bacterial Infections / Q000453:epidemiology; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010348:Patient Care Team; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult