Document Detail


Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement.
MedLine Citation:
PMID:  19350313     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We 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). METHODS: Between 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. RESULTS: Main 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. CONCLUSIONS: Our 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.
Authors:
Michele Musci; Yuguo Weng; Michael Hübler; Tito Chavez; Naser Qedra; Susanne Kosky; Julia Stein; Henryk Siniawski; Roland Hetzer
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-04-07
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  98     ISSN:  1861-0692     ISO Abbreviation:  -     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-07     Completed Date:  2009-10-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  443-50     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. musci@dhzb.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Valve / surgery*
Bacterial Infections / epidemiology
Blood Vessel Prosthesis / adverse effects*,  microbiology
Child
Child, Preschool
Endocarditis, Bacterial / microbiology,  mortality*
Female
Humans
Infant
Longitudinal Studies
Male
Middle Aged
Multiple Organ Failure / etiology
Patient Care Team
Predictive Value of Tests
Retrospective Studies
Sepsis / etiology
Survival Analysis
Transplantation, Homologous
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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