Thorac Cardiovasc Surg 2014; 62 - OP119
DOI: 10.1055/s-0034-1367193

Detrimental impact of prosthetic aortic endocarditis on early and long-term outcome: Results from a Multicenter European Initiative

G. Santarpino 1, F. Biancari 2, F. Onorati 3, G. Mariscalco 4, M. De Feo 5, A. Messina 6, F. Santini 7, C. Beghi 3, G. Nappi 5, G. Troise 6, G. Passerone 7, J. Heikkinen 2, G. Faggian 3, T. Fischlein 1
  • 1Klinikum Nürnberg, Cardiac Surgery, Nürnberg, Germany
  • 2University of Oulu, Cardiac Surgery, Oulu, Finland
  • 3University of Verona Medical School, Cardiac Surgery, Verona, Italy
  • 4Varese University Hospital, Varese, Italy
  • 5Second University of Naples, Department of Cardiothoracic and Respiratory Sciences, Napoli, Italy
  • 6Poliambulanza Foundation Hospital, Brescia, Cardiac Surgery, Brescia, Italy
  • 7San Martino University Hospital Genoa, Cardiac Surgery, Genoa, Italy

Objectives: To evaluate the impact of prosthetic aortic valve endocarditis (pAVE) in the multicenter European “RECORD” (Redo Cardiac Operation Research Database) Initiative.

Methods: Early-to-long term results in redo-AVR for pAVE during the last 10 years at 7 Institutions were compared to those achieved in the absence of pAVE. Determinants of mortality and acute heart failure (AHF) were analyzed.

Results: One-hundred-fifty-four patients (21.7%) out of 711 redo-AVR had pAVE. Patients with pAVE showed higher hospital mortality (9.7% vs 3.8%, p = .006), higher major cardiovascular re-entry complications (p = .005), transfusions (p = .0001), perioperative low-output syndrome (p = .0001), intraaortic balloon pumping (p = .017), stroke (p = .005), respiratory failure (p = .05), prolonged intubation (p = .0001), pneumonia (p = .002), acute renal insufficiency (p = .0001), renal replacement therapy (p = .008), permanent pacemaker (p = .003). Ten-year actuarial survival was reduced by pAVE (43.3 ± 7.0% vs 88.1 ± 2.3%, p = .0001), as well as freedom from AHF (p = .0001, Fig.1 left panel) and re-interventions (p = .0001, Fig.1 right panel). pAVE was an independent predictor of mortality (p = .0001; O.R. 8.2, 95% C.I. 4.3 - 15.8) and AHF (p = .003; O.R. 3.5, 95% C.I. 1.5-8.0). Results of pAVE in the last 5-years did not differ from those of previous 5-years in all early and long-term endpoints. Interestingly, implantation of biologic (vs mechanical) prostheses for pAVE determined similar 10-year survival (p = NS) but lower freedom from AHF (p = .023).

Conclusion: pAVE still represents a major challenge with poor early and long-term results.

Fig. 1