Endocarditis in patients with ascending aortic prosthetic graft: a case series from a national multicentre registry.
OBJECTIVE
Endocarditis in patients with ascending aortic prosthetic graft (AAPG) is a life-threatening complication. The purpose of this study was to examine the clinical presentation and prognosis of patients with AAPG endocarditis included in a large prospective infectious endocarditis multicentre study.


METHODS
From January 2008 to April 2015, 3200 consecutive patients with infectious endocarditis according to the modified Duke criteria, were prospectively included in the 'Spanish Collaboration on Endocarditis Registry (GAMES)' registry. Twenty-seven definite episodes of endocarditis (0.8%) occurred in patients with AAPG.


RESULTS
During the study period, 27 cases of endocarditis were detected in patients with AAPG. The median age of patients was 61 years [interquartile range (IQR) 51-68 years] and 23 (85.2%) patients were male. The median time from AAPG surgery to the episode of AAPG infection was 24 months (IQR 6-108 months). The most frequently isolated micro-organisms were coagulase-negative staphylococci and S. aureus (11 patients, 40.7%). Four patients (14.8%) underwent medical treatment, whereas surgery was performed in 21 (77.7%). Two patients (7.4%) died before surgery could be performed. The median hospital stay prior to surgery was 7 days (IQR 4-21 days). Surgery consisted of replacing previous grafts with a composite aortic graft (10 cases) or aortic homograft (2 patients), and removal of a large vegetation attached to the valve of a composite tube (1 case). Nine patients had an infected aortic valve prosthesis without evidence of involvement of the AAPG. Isolated redo-aortic valve replacement was performed in 8 (88.9%) of these patients. Reinfection occurring during 1 year of follow-up was not detected in any patient. Two patients (7.4%) died while awaiting surgery and 6 did so after surgery (22.2%). A New York Heart Association (NYHA) Class IV was associated with mortality in patients undergoing surgery (P < 0.019).


CONCLUSIONS
Most cases of endocarditis in patients with AAPG occur late after initial surgery. Mortality rate of patients with AAPG endocarditis who undergo surgery is acceptable. NYHA Class IV before surgery is associated with an increased postoperative mortality.
Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain aramos220@gmail.com.
Antonio
A
Ramos
Department of Heart Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Carlos
C
García-Montero
Department of Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain.
Alfonso
A
Moreno
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Maranon, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Patricia
P
Muñoz
Department of Infectious Diseases UGC, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Josefa
J
Ruiz-Morales
Department of Heart Surgery UGC, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Gemma
G
Sánchez-Espín
Department of Heart Surgery UGC, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Carlos
C
Porras
Department of Infectious Diseases, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Dolores
D
Sousa
Department of Infectious Diseases, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Laura
L
Castelo
Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
María
M
Del Carmen Fariñas
Department of Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Francisco
F
Gutiérrez
Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain.
José María
JM
Reguera
Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain.
Antonio
A
Plata
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Emilio
E
Bouza
Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain.
Isabel
I
Antorrena
Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Arístides
A
de Alarcón
Department of Infectious Diseases, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
José Manuel
JM
Pericás
Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.
Mercedes
M
Gurguí
Department of Heart Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Hugo
H
Rodríguez-Abella
Department of Infectious Diseases, Hospital Universitario Donosti, San Sebastián, Spain.
Miguel
M
Ángel Goenaga
Department of Infectious Diseases, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Madrid, Spain.
José
J
Antonio Oteo
Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Pablo
P
García-Pavía
D000368:Aged; D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D058017:Vascular Grafting / Q000009:adverse effects* / Q000379:methods
Aorta, Thoracic; Endocarditis; Propionibacterium acnes; Staphylococcus aureus; Vascular grafting