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

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Abstract

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.

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Abbreviations

ARR:

Aortic root replacement

AIE:

Active infective endocarditis

CI:

Confidence interval

ICU:

Intensive care unit

MOF:

Multiorgan failure

NVE:

Native valve endocarditis

OR:

Odds ratio

POD:

Postoperative day

PVE:

Prosthetic valve endocarditis

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Acknowledgments

We thank Mrs. A. Benhennour for bibliographic assistance, Mrs. K. Weber for photographic work and Mrs. A. Gale for editorial assistance.

Conflict of interest statement

There is no financial relationship with any corporate sponsor that might relate in any way to the subject presented.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

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

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  1. Michele Musci
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  2. Yuguo Weng
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  3. Michael Hübler
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Correspondence to Michele Musci.

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Musci, M., Weng, Y., Hübler, M. et al. Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement. Clin Res Cardiol 98, 443–450 (2009). https://doi.org/10.1007/s00392-009-0015-3

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  • DOI: https://doi.org/10.1007/s00392-009-0015-3

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