Background
Methods
Study design
Definition of IE and indication for surgery
Data collection
Reporting mortality
Statistical analysis
Results
Preoperative characteristics and risk factors
ENTIRE COHORT | PROPENSITY MATCHED COHORT | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
NVE (n = 315) | PVE (n = 103) | P value | NVE (n = 79) | PVE (n = 79) | P value | |||||
Age | 62.7 | [49.4–71.6] | 71.5 | [62.0–76.6] | < 0.001 | 65.5 | [55.5–72.2] | 69.2 | [55.5–75.5] | 0.204 |
Female sex | 71 | (22.5%) | 33 | (32.0%) | 0.046 | 22 | (27.8%) | 19 | (24.1%) | 0.586 |
BMI | 25.5 | [23.2–28.1] | 26.0 | [23.9–28.7] | 0.273 | 25.4 | [23.7–28.8] | 26.1 | [23.9–28.7] | 0.548 |
BSA | 1.98 | [1.83–2.12] | 1.94 | [1.74–2.10] | 0.238 | 1.97 | ± 0.21 | 1.97 | ± 0.24 | 0.349 |
COPD | 29 | (9.2%) | 9 | (8.7%) | 0.886 | 10 | (12.7%) | 8 | (10.1%) | 0.617 |
Diabetes | 81 | (25.7%) | 34 | (33.0%) | 0.150 | 21 | (26.6%) | 25 | (31.6%) | 0.484 |
Peripheral vascular disease | 23 | (7.3%) | 12 | (11.7%) | 0.167 | 6 | (7.6%) | 7 | (8.9%) | 0.772 |
Preoperative AKI | 173 | (54.9%) | 69 | (67.0%) | 0.031 | 54 | (68.4%) | 52 | (65.8%) | 0.735 |
Preoperative dialysis | 30 | (9.5%) | 13 | (12.6%) | 0.889 | 6 | (7.6%) | 13 | (16.5%) | 0.176 |
Coronary artery disease | 80 | (25.4%) | 36 | (35.5%) | 0.060 | 23 | (29.1%) | 22 | (27.8%) | 0.860 |
Prior PCI | 18 | (5.7%) | 14 | (13.6%) | 0.054 | 4 | (5.1%) | 8 | (10.1%) | 0.124 |
Immunosuppression | 5 | (1.6%) | 2 | (1.9%) | 0.811 | 1 | (1.3%) | 1 | (1.3%) | 1.000 |
HIV | 9 | (2.9%) | 1 | (1.0%) | 0.233 | 0 | (0%) | 1 | (1.3%) | 0.238 |
Alcohol abuse | 37 | (11.7%) | 4 | (3.9%) | 0.020 | 8 | (10.1%) | 3 | (3.8%) | 0.118 |
Intravenous drug abuse | 22 | (7.0%) | 6 | (5.8%) | 0.683 | 5 | (6.3%) | 6 | (7.6%) | 0.755 |
History of neoplasm | 33 | (10.5%) | 10 | (9.7%) | 0.824 | 12 | (15.2%) | 6 | (7.6%) | 0.133 |
LVEF | ||||||||||
< 30% | 7 | (2.2%) | 2 | (1.9%) | 0.865 | 1 | (1.3%) | 2 | (2.5%) | 0.559 |
30–50% | 63 | (20%) | 30 | (29.1%) | 0.532 | 16 | (20.3%) | 23 | (29.1%) | 0.268 |
> 50% | 238 | (75.6%) | 70 | (70.0%) | 0.129 | 62 | (78.5%) | 53 | (67.1%) | 0.108 |
NYHA class | ||||||||||
I + II | 55 | (17.5%) | 19 | (18.4%) | 0.925 | 20 | (25.3%) | 14 | (17.7%) | 0.245 |
III + IV | 251 | (80.0%) | 80 | (77.7%) | 0.662 | 59 | (74.7%) | 63 | (79.7%) | 0.448 |
Log. EuroSCORE | 7.6 | [4.4–18.1] | 9.8 | [22.3–36.2] | < 0.001 | 7.9 | [4.1–16.3] | 17.5 | [7.9–33.7] | < 0.001 |
EuroSCORE II | 7.0 | [5.0–10.0] | 11.0 | [8.0–13.0] | < 0.001 | 7.0 | [5.0–9.0] | 10.0 | [7.0–12.3] | < 0.001 |
ENTIRE COHORT | PROPENSITY MATCHED COHORT | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
NVE (n = 315) | PVE (n = 103) | P value | NVE (n = 315) | PVE (n = 103) | P value | |||||
MICROBIOLOGY | ||||||||||
Positive Blood culture | 263 | (83.5%) | 77 | (74.8%) | 0.279 | 65 | (82.3%) | 58 | (73.4%) | 0.505 |
Streptococcus spp | 84 | (26.7%) | 10 | (9.7%) | < 0.001 | 20 | (25.3%) | 8 | (10.1%) | 0.011 |
Staphylococcus spp | 98 | (31.1%) | 35 | (34.0%) | 0.587 | 20 | (25.3%) | 24 | (30.4%) | 0.478 |
Staph. aureus | 74 | (23.5%) | 19 | (18.4%) | 0.285 | 16 | (20.3%) | 15 | (19.0%) | 0.841 |
CoNS | 26 | (8.3%) | 16 | (15.5%) | 0.033 | 5 | (6.3%) | 9 | (11.4%) | 0.263 |
Enterococcus spp | 44 | (14.0%) | 17 | (16.5%) | 0.527 | 15 | (19.0%) | 16 | (20.3%) | 0.841 |
ECHOCARDIOGRAPHY | ||||||||||
Vegetation | 259 | (82.2%) | 73 | (70.9%) | 0.017 | 65 | (82.3%) | 59 | (74.7%) | 0.307 |
Vegetation length (cm) | 1.6 | [1.1–2.0] | 1.2 | [0.8–1.7] | 0.009 | 1.5 | ± 0.6 | 1.3 | ± 0.7 | 0.357 |
Leftsided IE | ||||||||||
Aortic valve | 166 | (52.7%) | 81 | (78.6%) | < 0.001 | 52 | (65.8%) | 58 | (73.4%) | 0.299 |
Mitral valve | 171 | (54.3%) | 26 | (25.2%) | < 0.001 | 23 | (29.1%) | 26 | (32.9%) | 0.606 |
Rightsided IE | ||||||||||
Tricuspid valve | 21 | (6.7%) | 1 | (1.0%) | 0.046 | 6 | (7.6%) | 1 | (1.3%) | 0.053 |
Pulmonary valve | 1 | (0.3%) | 1 | (1.0%) | 0.439 | 0 | (0%) | 1 | (1.3%) | 0.238 |
Perivalvular infection | ||||||||||
Perivalvular abscess | 85 | (27.0%) | 62 | (60.2%) | < 0.001 | 21 | (26.6%) | 41 | (51.9%) | 0.001 |
Perforation | 83 | (26.3%) | 21 | (20.4%) | 0.224 | 10 | (12.7%) | 19 | (24.1%) | 0.064 |
Fistula | 1 | (0.3%) | 13 | (12.6%) | < 0.001 | 1 | (1.3%) | 10 | (12.7%) | 0.005 |
SYMPTOMS | ||||||||||
Fever | 201 | (63.8%) | 72 | (69.9%) | 0.259 | 60 | (75.9%) | 55 | (69.6%) | 0.371 |
Sepsis | 233 | (74.0%) | 68 | (66.0%) | 0.119 | 41 | (51.9%) | 38 | (48.1%) | 0.633 |
IE-related neurologic complications | 99 | (31.4%) | 28 | (27.2%) | 0.416 | 23 | (29.1%) | 22 | (27.8%) | 0.860 |
TIA | 13 | (4.1%) | 1 | (1.0%) | 0.122 | 3 | (3.8%) | 0 | (0%) | 0.305 |
Stroke | 47 | (14.9%) | 17 | (16.5%) | 0.698 | 11 | (13.9%) | 14 | (17.7%) | 0.513 |
Intracranial bleeding | 5 | (1.6%) | 3 | (2.9%) | 0.394 | 1 | (1.3%) | 3 | (3.8%) | 0.311 |
Other | 33 | (10.5%) | 7 | (6.8%) | 0.270 | 8 | (10.1%) | 5 | (6.3%) | 0.385 |
Septic embolism | 115 | (36.5%) | 29 | (28.2%) | 0.188 | 25 | (31.6%) | 24 | (30.4%) | 0.239 |
Cardiogenic shock | 46 | (14.6%) | 9 | (8.7%) | 0.126 | 7 | (8.9%) | 8 | (10.1%) | 0.786 |
30-day and 1-year clinical outcomes
ENTIRE COHORT | PROPENSITY MATCHED COHORT | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
NVE (n = 315) | PVE (n = 103) | P value | NVE (n = 315) | PVE (n = 103) | P value | |||||
30-DAY OUTCOME | ||||||||||
30-day mortality | 26 | (8.3%) | 22 | (21.4%) | < 0.001 | 4 | (5.1%) | 16 | (20.3%) | 0.004 |
Myocardial infarction | 1 | (0.3%) | 1 | (1.0%) | 0.439 | 0 | (0%) | 1 | (1.3%) | 0.238 |
New pacemaker * | 23 | (7.3%) | 20 | (19.4%) | < 0.001 | 8 | (10.1%) | 11 | (13.9%) | 0.463 |
New postoperative cerebrovascular events | 15 | (4.8%) | 8 | (7.8%) | 0.252 | 6 | (7.6%) | 4 | (5.1%) | 0.499 |
Stroke | 14 | (4.4%) | 5 | (4.9%) | 0.862 | 6 | (7.6%) | 3 | (3.8%) | 0.294 |
Intracranial bleeding | 1 | (0.3%) | 3 | (2.9%) | 0.077 | 0 | (0%) | 1 | (1.3%) | 0.238 |
Postoperative AKI | 107 | (34.0%) | 47 | (45.6%) | 0.035 | 33 | (41.8%) | 32 | (40.5%) | 0.872 |
Re-exploration for bleeding | 45 | (14.3%) | 26 | (25.2%) | 0.009 | 10 | (12.7%) | 17 | (21.5%) | 0.129 |
Tracheostomy | 38 | (12.1%) | 21 | (20.4%) | 0.036 | 10 | (12.7%) | 15 | (19.0%) | 0.276 |
Time of ventilation (h) | 18.2 | [11–68] | 32.8 | [17–120] | < 0.001 | 16.8 | [12–46] | 28.3 | [15–113] | 0.017 |
ICU stay (d) | 4.0 | [2.0–8.0] | 5.0 | [3.0–13.0] | 0.009 | 3.0 | [1.0–6.0] | 5.0 | [2.0–12.0] | 0.042 |
Hospital stay (d) | 12.0 | [8.0–16.0] | 14.5 | [10.0–20.0] | 0.007 | 12.0 | [7.0–17.0] | 15.0 | [11.0–20.0] | 0.015 |
1-YEAR OUTCOME | ||||||||||
1-year mortality | 53 | (16.8%) | 34 | (33.0%) | < 0.001 | 11 | (13.9%) | 23 | (29.1%) | 0.020 |
Re-admission to hospital | 94 | (29.8%) | 33 | (32.0%) | 0.478 | 31 | (39.2%) | 23 | (29.1%) | 0.835 |
Relapse of endocarditis | 10 | (3.2%) | 3 | (2.9%) | 0.938 | 3 | (3.8%) | 2 | (2.5%) | 1.000 |
New pacemaker* | 5 | (1.6%) | 4 | (3.9%) | 0.177 | 2 | (2.5%) | 1 | (1.3%) | 0.792 |
AKI during follow-up | 23 | (7.3%) | 13 | (12.6%) | 0.071 | 11 | (13.9%) | 8 | (10.1%) | 0.883 |
Factors associated with mortality
INDEPENDENT RISK FACTORS FOR 30-DAY MORTALITY | |||
---|---|---|---|
OR | 95%CI | P value | |
PVE | 2.699 | 1.496–4.871 | 0.001 |
Preoperative AKI | 2.720 | 1.307–5.657 | 0.007 |
Preoperative sepsis | 2.281 | 1.123–4.636 | 0.023 |
Perivalvular abscess | 1.864 | 1.002–3.465 | 0.049 |
Patients with perivalvular abscess
- Perivalvular abscess (n = 275) | + Perivalvular abscess (n = 148) | P value | |
---|---|---|---|
Age | 64.3 [50.6–72.9] | 65.0 [50.3–74.0] | 0.778 |
Female sex | 61 (22.3%) | 43 (29.1%) | 0.122 |
BMI | 25.8 [23.5–28.3] | 25.4 [23.4–28.7] | 0.597 |
BSA | 1.98 [1.83–2.12] | 1.96 [1.74–1.96] | 0.309 |
COPD | 26 (9.5%) | 14 (9.5%) | 0.999 |
Diabetes | 78 (28.4%) | 39 (26.4%) | 0.659 |
Peripheral vascular disease | 17 (6.2%) | 18 (12.2%) | 0.033 |
Preoperative AKI | 156 (56.7%) | 90 (60.8%) | 0.417 |
Coronary artery disease | 71 (25.8%) | 46 (31.1%) | 0.248 |
Immunosuppression | 3 (1.1%) | 4 (2.7%) | 0.229 |
HIV | 6 (2.2%) | 4 (2.7%) | 0.739 |
Alcohol abuse | 26 (9.5%) | 15 (10.1%) | 0.821 |
Intravenous drug abuse | 19 (6.9%) | 9 (6.1%) | 0.774 |
History of neoplasm | 27 (9.8%) | 16 (10.8%) | 0.747 |
LVEF | |||
< 30% | 4 (1.5%) | 5 (3.4%) | 0.201 |
30–50% | 61 (22.8%) | 33 (22.4%) | 0.942 |
> 50% | 203 (75.7%) | 109 (74.1%) | 0.809 |
MICROBIOLOGY | |||
Positive Blood culture | 224 (89.6%) | 119 (84.4%) | 0.132 |
Streptococcus spp. | 69 (25.1%) | 26 (17.6%) | 0.077 |
Staphylococcus spp. | 83 (30.2%) | 51 (34.5%) | 0.367 |
Staph aureus | 61 (22.2%) | 33 (22.3%) | 0.978 |
CoNS | 23 (8.4%) | 19 (12.8%) | 0.142 |
Enterococcus spp. | 39 (14.2%) | 22 (14.9%) | 0.849 |
ECHOCARDIOGRAPHY | |||
Vegetation | 226 (82.5%) | 110 (74.8%) | 0.062 |
Leftsided IE | |||
Aortic valve | 136 (49.5%) | 113 (76.4%) | < 0.001 |
Mitral valve | 154 (56.0%) | 50 (33.8%) | < 0.001 |
Rightsided IE | |||
Tricuspid valve | 19 (6.9%) | 4 (2.7%) | 0.069 |
Pulmonary valve | 1 (0.7%) | 1 (0.4%) | 0.663 |
SYMPTOMS | |||
Fever | 169 (61.5%) | 107 (72.3%) | 0.026 |
Sepsis | 136 (49.5%) | 84 (56.8%) | 0.152 |
IE-related neurologic complications | 85 (30.9%) | 43 (29.1%) | 0.692 |
Septic embolism | 99 (36.1%) | 47 (32.2%) | 0.658 |
Cardiogenic shock | 31 (11.3%) | 25 (16.9%) | 0.104 |
OPERATION | |||
Operation time (min) | 195 [155–245] | 230 [178–314] | < 0.001 |
CPB time (min) | 106 [83–142] | 138 [100–182] | < 0.001 |
Crossclamp time (min) | 69 [53–95] | 87 [67–115] | < 0.001 |
30-DAY OUTCOME | |||
30-day mortality | 22 (8.0%) | 26 (17.7%) | 0.003 |
Myocardial infarction | 1 (0.4%) | 1 (0.7%) | 0.663 |
New pacemaker * | 20 (7.3%) | 23 (15.5%) | 0.007 |
New postoperative cerebrovascular events | 11 (4.0%) | 13 (8.8%) | 0.042 |
Postoperative AKI | 91 (33.1%) | 67 (45.6%) | 0.012 |
Re-exploration for bleeding | 43 (15.7%) | 28 (18.9%) | 0.398 |
Tracheostomy | 33 (12.0%) | 26 (17.7%) | 0.108 |
Time of ventilation (h) | 19.8 [12.0–68.9] | 26.6 [12.3–117.6] | 0.118 |
ICU stay (d) | 4.0 [2.0–8.0] | 5.0 [2.0–10.0] | 0.103 |
Hospital stay (d) | 12.0 [9.0–17.0] | 12.0 [9.0–17.0] | 0.992 |
1-YEAR OUTCOME | |||
1-year mortality | 35 (22.3%) | 18 (20.9%) | 0.806 |
Re-admission to hospital | 86 (58.5%) | 44 (55.0%) | 0.610 |
Relapse of endocarditis | 10 (6.9%) | 4 (5.3%) | 0.631 |
AKI during follow-up | 23 (15.9%) | 14 (18.2%) | 0.659 |