Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-04-07

AUTHORS

Michele Musci, Yuguo Weng, Michael Hübler, Tito Chavez, Naser Qedra, Susanne Kosky, Julia Stein, Henryk Siniawski, Roland Hetzer

ABSTRACT

PurposeWe compared early results of homograft aortic root replacement (ARR) in native (NVE) and prosthetic (PVE) aortic valve endocarditis in order to identify predictors for early mortality (<30 days).MethodsBetween 05/1986 and 12/2007, 1,163 endocarditis patients were operated upon. Of these, 221 patients (n = 185 men, median age 55 years) underwent homograft ARR due to 99 cases of NVE (45%) and 122 of PVE (55%) aortic root endocarditis. Demographics, clinical differences, survival rates and predictors of early mortality were analyzed. Follow-up (mean 5.2 ± 0.4 years, maximum 18.4 years) was completed in 96.8% with a total of 1,127 patient years.ResultsMain causes of the 47 (21.2%) early deaths were septic multiorgan failure in 23 (48.9%) and myocardial failure in 10 (21.3%) patients with a significantly better survival for NVE than for PVE patients (patients = 0.029). The highest ORs were found in the univariate analysis for preoperative development of septic shock (OR 14.28), preoperative necessity of ventilation (OR 7.08), high doses of catecholamines (OR 5.60), severe aortic root destruction (OR 5.12), emergency operation (OR 4.25) and persistent fever despite antibiotic treatment (OR 4.11). Multivariate analysis showed that preoperative ventilation (OR 5.43), persistent fever under antibiotic treatment (OR 2.84) and prosthetic endocarditis (OR 2.32) were independent risk factors for early mortality.ConclusionsOur results suggest that early outcome could be improved if patients were referred earlier for surgery. A multidisciplinary approach is necessary, involving at least specialists in intensive care medicine, cardiology, infectious disease and cardiac surgery in order to identify the optimal time for surgery and decrease early mortality. More... »

PAGES

443-450

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00392-009-0015-3

DOI

http://dx.doi.org/10.1007/s00392-009-0015-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1026661908

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19350313


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48 antibiotic treatment
49 aortic root destruction
50 aortic root endocarditis
51 aortic root replacement
52 aortic valve endocarditis
53 approach
54 better survival
55 cardiac surgery
56 cardiology
57 care medicine
58 cases
59 cases of NVE
60 catecholamines
61 cause
62 clinical differences
63 death
64 demographics
65 destruction
66 development
67 differences
68 disease
69 doses
70 earlier results
71 early death
72 early mortality
73 early outcomes
74 emergency operation
75 endocarditis
76 endocarditis patients
77 factors
78 failure
79 fever
80 high doses
81 higher ORs
82 homograft aortic root replacement
83 independent risk factor
84 infectious diseases
85 intensive care medicine
86 least specialists
87 medicine
88 mortality
89 multidisciplinary approach
90 multiorgan failure
91 multivariate analysis
92 myocardial failure
93 necessity
94 operation
95 optimal time
96 order
97 outcomes
98 patient years
99 patients
100 persistent fever
101 predictors
102 preoperative development
103 preoperative necessity
104 preoperative ventilation
105 prosthetic aortic root endocarditis
106 prosthetic aortic valve endocarditis
107 prosthetic endocarditis
108 rate
109 replacement
110 results
111 risk factors
112 root destruction
113 root endocarditis
114 root replacement
115 septic multiorgan failure
116 septic shock
117 severe aortic root destruction
118 shock
119 specialists
120 surgery
121 survival
122 survival rate
123 time
124 total
125 treatment
126 univariate analysis
127 valve endocarditis
128 ventilation
129 years
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