Risk Factors Predicting the Postoperative Outcome in 134 Patients with Active Endocarditis

Authors

  • Siyamek Neragi-Miandoab
  • Edvard Skripochnik
  • Robert Michler
  • David D'Alessandro

DOI:

https://doi.org/10.1532/HSF98.2013270

Abstract

Background: Surgery remains the cornerstone in management of endocarditis.

Methods: In this retrospective cohort we evaluated the operative outcome of patients with infective endocarditis. The SPSS program was used to analyze the data.

Results: A total of 134 predominantly male patients (60%) with a mean age of 55 ± 12.4 years were examined. The procedures included single valve (n = 88; 66%), double/multiple valves (n = 29; 22%), and valve-coronary artery bypass graft (CABG) (n = 16; 12%). Perioperative mortality was 11.9% (n = 16). In the multivariate analysis, dialysis (odds ratio [OR] = 7.88; 95% confidence interval [CI] [1.78-34.77]; P = .006), sepsis (OR = 19.5; 95% CI [2.76-137.9]; P = .002), and perfusion time (95% CI [1.00-1.02]; P = .003) were independent predictors of perioperative mortality. The overall long-term survival at 28 months was 69.2% ± 4%. Dialysis (P = .0001) was a predictor of mortality, whereas elevated creatinine in nondialysis patients (P = .0002) was not. In the multivariate analysis, dialysis (hazard ratio [HR] 4.06%; 95% CI [0.936-8.526]; P = .0002), CABG (HR 2.32; 95% CI [1.086-4.978]; P = .0299), chronic obstructive pulmonary disease (HR 2.20; 95% CI [1.027-4.739]; P = .0426), and double/multiple valve procedure (HR 3.0; 95% CI [1.467-6.206]; P = .0027) were risk factors for long-term mortality.

Conclusion: Renal failure but not renal insufficiency is a risk factor for short and long-term mortality.

References

Forrest GN, Arnold RS, Gammie JS, Gilliam BL. 2011. Single center experience of a vancomycin resistant enterococcal endocarditis cohort. J Infect 63:420-8.nFunakoshi S, Kaji S, Yamamuro A, et al. 2011. Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg 142:836-42.e1.nGutierrez-Martin MA, Galvez-Aceval J, Araji OA. 2010. Indications for surgery and operative techniques in infective endocarditis in the present day. Infect Disord Drug Targets 10:32-46.nKang DH, Kim YJ, Kim SH, et al. 2012. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 366:2466-73.nKiefer T, Park L, Tribouilloy C, et al. 2011. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA 306:2239-47.nLeone S, Ravasio V, Durante-Mangoni E, et al. 2012. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection 40:527-35.nLopez J, Revilla A, Vilacosta I, et al. 2011. Multiple-valve infective endocarditis: clinical, microbiologic, echocardiographic, and prognostic profile. Medicine 90:231-6.nManne MB, Shrestha NK, Lytle BW, et al. 2012. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012;93:489-93.nMeszaros K, Nujic S, Sodeck GH, et al. 2012. Long-term results after operations for active infective endocarditis in native and prosthetic valves. Ann Thorac Surg 94:1204-10.nMokhles MM, Ciampichetti I, Head SJ, Takkenberg JJ, Bogers AJ. 2011. Survival of surgically treated infective endocarditis: a comparison with the general Dutch population. Ann Thorac Surg 91:1407-12.nMokhles MM, Ciampichetti I, van Domburg R, Cheng JM, Bogers AJ, Witsenburg M. 2012. Infective endocarditis in a tertiary referral hospital: long-term follow up. J Heart Valve Dis 21:118-24.nOhara T, Nakatani S, Kokubo Y, et al. 2012. Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nation-wide survey in Japan. Int J Cardiol 67:2688-94.nRankin JS, Milford-Beland S, O'Brien SM, et al. 2007. The risk of valve surgery for endocarditis in patients with dialysis-dependent renal failure. J Heart Valve Dis 16:617-22; discussion 22.nSheikh AM, Elhenawy AM, Maganti M, Armstrong S, David TE, Feindel CM. 2009. Outcomes of double valve surgery for active infective endocarditis. J Thorac Cardiovasc Surg 138:69-75.nTamura K, Arai H, Yoshizaki T. 2012. Long-term outcome of active infective endocarditis with renal insufficiency in cardiac surgery. Ann Thorac Cardiovasc Surg 18:216-21.nPolat A, Tuncer A, Tuncer EY, et al. 2012. Surgical treatment of culture-negative aortic infective endocarditis. Ann Thorac Surg 93:44-9.nShang E, Forrest GN, Chizmar T, et al. 2009. Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair. Ann Thorac Surg 87:1728-33; discussion 1734.nThuny F, Giorgi R, Habachi R, et al. 2012. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J 164:94-101.nWang A. 2011. Recent progress in the understanding of infective endocarditis. Curr Treat Options Cardiovasc Med 13:586-94.nYamaguchi H, Eishi K. 2007. Surgical treatment of active infective mitral valve endocarditis. Ann Thorac Cardiovasc Surg 13:150-5.n

Published

2014-03-14

How to Cite

Neragi-Miandoab, S., Skripochnik, E., Michler, R., & D’Alessandro, D. (2014). Risk Factors Predicting the Postoperative Outcome in 134 Patients with Active Endocarditis. The Heart Surgery Forum, 17(1), E35-E41. https://doi.org/10.1532/HSF98.2013270

Issue

Section

Articles