Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598774
Oral Presentations
Monday, February 13th, 2017
DGTHG: Acquired Heart Valve Disease: Endocarditis
Georg Thieme Verlag KG Stuttgart · New York

Chronic Infection of Stenotic Aortic Valves with Staphylococcus aureus: Implications for Perioperative Treatment?

E. Bagaev
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
M. Friedrich
2   Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
,
N. Schlichting
2   Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
,
Y. Kullnick
2   Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
,
N. Lidzba
2   Fraunhofer Institute Leipzig, Department of Diagnostics and New Technologies, Leipzig, Germany
,
M.S. Gruhle
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
M. Pichlmaier
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
F. Kuhr
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
M. Lühr
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
C. Hagl
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
,
A. Oberbach
1   Ludwig-Maximilians-University (LMU), Cardiac Surgery, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

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Objective: The pathogenesis of fibrosis or calcification of aortic valves is multifactorial and may be caused by infection status. Staphylococci aureus are the most common cause for surgically treated destructive infective endocarditis. The aim of our prospective study was to reveal whether fibrotic and/or calcific changes in aortic heart valves were associated with chronic infective pathogen infiltration. Additionally, serological investigations of blood antibodies against Staphylococcus aureus should provide insights into individual risk profiles.

Methods: 58 consecutive patients who underwent aortic valve replacement were included in the analysis. All patients were free of clinical signs of infective endocarditis including blood culture testing. From heart valve tissue, DNA was extracted followed by 16S-rDNA-PCR and qPCR to quantify a potential infective stage of Staphylococcus aureus. Histological fluorescence gram staining by hexidium iodide and SYTO13 was used to prove intramural bacterial localization in heart valve tissue. Furthermore, serological testing of IgA, IgM and IgG antibodies against Staphylococcus aureus was performed.

Results: In all 58 patients (40 males, 18 females), 16S-rDNA-PCR was positive, representing bacterial infection stage. Out of those, four cases were positive tested for S. aureus by quantitative PCR analysis. Histological fluorescence staining demonstrated a strong intramural bacterial localization. Serological analysis of S. aureus antibodies revealed IgA in 22%, IgM in 24% and IgG in 12%.

Conclusion: The analysis of fibrotic and calcified aortic valves revealed evidence of chronic inflammation in all patients, despite the lack of clinical signs or symptoms. Sophisticated serology analysis of patients' blood enables the detection of the individual risk for acute or chronic S. aureus infection. Based on the current findings, our assay may be applied for tailoring and monitoring peri- and postoperative antibiotic treatment.