Surgery for prosthetic valve endocarditis: a retrospective study of a national registry.
OBJECTIVE
We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.


METHODS
Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.


RESULTS
Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P  = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P  < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P  < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P  = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P  = 0.03), renal insufficiency (OR = 2.1; P  = 0.05), triple valve surgery (OR = 6.9; P  = 0.004) and shock (OR = 4.5; P  < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P  < 0.001), Enterococcus (OR = 2.3; P  = 0.01) and female sex (OR = 1.5; P  = 0.03) independently predicted complications, whereas ejection fraction was protective.


CONCLUSIONS
PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Alessandro
A
Della Corte
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Michele
M
Di Mauro
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Guglielmo
G
Actis Dato
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Fabio
F
Barili
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Diego
D
Cugola
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Sandro
S
Gelsomino
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Pasquale
P
Santè
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Antonio
A
Carozza
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Ester
E
Della Ratta
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Lorenzo
L
Galletti
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Roger
R
Devotini
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Riccardo
R
Casabona
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Francesco
F
Santini
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Antonio
A
Salsano
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Roberto
R
Scrofani
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Carlo
C
Antona
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Carlo
C
De Vincentiis
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Andrea
A
Biondi
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Cesare
C
Beghi
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giangiuseppe
G
Cappabianca
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Michele
M
De Bonis
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Alberto
A
Pozzoli
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Francesco
F
Nicolini
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Filippo
F
Benassi
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Davide
D
Pacini
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Roberto
R
Di Bartolomeo
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Andrea
A
De Martino
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Uberto
U
Bortolotti
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Roberto
R
Lorusso
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Enrico
E
Vizzardi
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Gabriele
G
Di Giammarco
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Daniele
D
Marinelli
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Emmanuel
E
Villa
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giovanni
G
Troise
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Domenico
D
Paparella
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Vito
V
Margari
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Francesco
F
Tritto
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Girolamo
G
Damiani
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giuseppe
G
Scrascia
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Salvatore
S
Zaccaria
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Attilio
A
Renzulli
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giuseppe
G
Serraino
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giovanni
G
Mariscalco
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Daniele
D
Maselli
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Alessandro
A
Parolari
Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.
Giannantonio
G
Nappi
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
Early outcomes; Infective endocarditis; Predictors; Prosthetic valve endocarditis; Surgery