Pathogenesis, Long-Time Survival and Quality of Life after Surgical Therapy of Aortic Valve Endocarditis

Background: Aortic valve endocarditis (AVE) poses a high risk for affected patients and its treatment has seen a significant shift to surgically more demanding cases, particularly when located on prosthetic valves (PVE). The present study was designed to evaluate the predominant pathogenic microorganisms and compares the outcome of patients who underwent surgery for native (NVE) and prosthetic aortic valve endocarditis (PVE).

Methods: Between 2007 and 2022, 231 patients required surgical therapy for 233 episodes of infective AV endocarditis (130 NVE, 103 PVE). Perioperative data, postoperative course, reinfection rate, long-term survival, and the health-related quality of life (HRQOL) were assessed.

Results: The most common pathogen of microbiological sampling was Staphylococcus aureus with 24.9% (NVE 26.2%, PVE 23.3%, p =0.62). In 62.2% of patients (NVE 66.2%, PVE 57.3%, p =0.21), the focus, i.e., entry of the infection, could be identified. In-hospital mortality was 13.3% (NVE 8.5%, PVE 18.4%, p < 0.05). Multivariate logistic regression revealed aortic cross-clamp time > 76 min (OR: 23.1; 95% CI: 2.8–197.5; p = 0.004), chronic hemodialysis (OR: 11.2; 95% CI:3.5–36.3; p = 0.001), Staphylococcus aureus infection (OR: 4.1; 95% CI: 1.5–11.7; p = 0.007), and low left ventricular ejection fraction < 30% (OR: 3.7; 95% CI: 1.1–12.2; p = 0.04) to be independent predictors for an elevated in-hospital mortality. At a mean of 5.1 ± 4.0 years after discharge of 173 survivors, follow-up mortality was 39.2% (NVE 23.8%, PVE 19.4%, p =0.42). There were only 2 cases of recurrent endocarditis in the NVE group. 84.8% of survivors were in NYHA class I/II (NVE 85.0%, PVE 84.6%, p = 0.83). The current HRQOL score revealed a physical score of 12.0 ± 8.9 vs. 12.6 ± 8.9 (NVE vs. PVE) and an emotional score of 5.3 ± 5.6 vs. 4.6 ± 5.3 (NVE vs. PVE).

Conclusion: Surgery for infective aortic valve endocarditis demonstrated good overall surgical outcomes, excellent results regarding reinfection rates, and favorable long-term HRQOL.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024