Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement
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 (
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| Veröffentlicht in: | Clinical research in cardiology 2009-07, Vol.98 (7), p.443-450 |
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| creator | Musci, Michele Weng, Yuguo Hübler, Michael Chavez, Tito Qedra, Naser Kosky, Susanne Stein, Julia Siniawski, Henryk Hetzer, Roland |
| description | 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 ( |
| doi_str_mv | 10.1007/s00392-009-0015-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67458529</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2418705891</sourcerecordid><originalsourceid>FETCH-LOGICAL-c369t-95256178d3a2cc0797c5d7e5a93bf061f1c2af7c2bfc5905f9b3e30c6a12cb133</originalsourceid><addsrcrecordid>eNp1kc2OFCEUhYlx4oyjD-DGEBfuyrlAU1UszWT8SSbRxcyaUNSlm0kVtEBp-lV8Wmmr40QTF-TcwMe5Fw4hrxi8YwDdVQYQijcAqi4mG_GEXLC-ZQ20ij_9U_ebc_I85wcAyUBsnpFzpoQEwcQF-fk14ehtiSnT6CiaNB3oHFMxky8H6gPdm-IxlEx_-LKjxhb_Heu-w7UK5rfERPcp5rLD4i011aBKirFQDGO0Jo2--EyXMGLaRh-2dBfnuE3Glb_ohPvJWJxrxxfkzJkp48uTXpL7Dzd315-a2y8fP1-_v22saFVplOSyZV0_CsOthU51Vo4dSqPE4KBljlluXGf54KxUIJ0aBAqwrWHcDkyIS_J29a0P-LZgLnr22eI0mYBxybrtNrKXXFXwzT_gQ1xSqLPpvmdCCQZ9hdgK2fodOaHT--Rnkw6agT6mptfUdE1NH1PTxwlen4yXYcbx8cYppgrwFcj1KGwxPXb-v-svVRGmiw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>881393108</pqid></control><display><type>article</type><title>Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Musci, Michele ; Weng, Yuguo ; Hübler, Michael ; Chavez, Tito ; Qedra, Naser ; Kosky, Susanne ; Stein, Julia ; Siniawski, Henryk ; Hetzer, Roland</creator><creatorcontrib>Musci, Michele ; Weng, Yuguo ; Hübler, Michael ; Chavez, Tito ; Qedra, Naser ; Kosky, Susanne ; Stein, Julia ; Siniawski, Henryk ; Hetzer, Roland</creatorcontrib><description>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.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-009-0015-3</identifier><identifier>PMID: 19350313</identifier><language>eng</language><publisher>Heidelberg: D. Steinkopff-Verlag</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aortic Valve - surgery ; Bacterial Infections - epidemiology ; Blood Vessel Prosthesis - adverse effects ; Blood Vessel Prosthesis - microbiology ; Cardiology ; Child ; Child, Preschool ; Endocarditis, Bacterial - microbiology ; Endocarditis, Bacterial - mortality ; Female ; Humans ; Infant ; Longitudinal Studies ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Multiple Organ Failure - etiology ; Multivariate analysis ; Original Paper ; Patient Care Team ; Predictive Value of Tests ; Prostheses ; Retrospective Studies ; Sepsis - etiology ; Survival Analysis ; Transplantation, Homologous ; Ventilation ; Young Adult</subject><ispartof>Clinical research in cardiology, 2009-07, Vol.98 (7), p.443-450</ispartof><rights>Springer-Verlag 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c369t-95256178d3a2cc0797c5d7e5a93bf061f1c2af7c2bfc5905f9b3e30c6a12cb133</citedby><cites>FETCH-LOGICAL-c369t-95256178d3a2cc0797c5d7e5a93bf061f1c2af7c2bfc5905f9b3e30c6a12cb133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-009-0015-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-009-0015-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19350313$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Musci, Michele</creatorcontrib><creatorcontrib>Weng, Yuguo</creatorcontrib><creatorcontrib>Hübler, Michael</creatorcontrib><creatorcontrib>Chavez, Tito</creatorcontrib><creatorcontrib>Qedra, Naser</creatorcontrib><creatorcontrib>Kosky, Susanne</creatorcontrib><creatorcontrib>Stein, Julia</creatorcontrib><creatorcontrib>Siniawski, Henryk</creatorcontrib><creatorcontrib>Hetzer, Roland</creatorcontrib><title>Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - surgery</subject><subject>Bacterial Infections - epidemiology</subject><subject>Blood Vessel Prosthesis - adverse effects</subject><subject>Blood Vessel Prosthesis - microbiology</subject><subject>Cardiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Endocarditis, Bacterial - microbiology</subject><subject>Endocarditis, Bacterial - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multiple Organ Failure - etiology</subject><subject>Multivariate analysis</subject><subject>Original Paper</subject><subject>Patient Care Team</subject><subject>Predictive Value of Tests</subject><subject>Prostheses</subject><subject>Retrospective Studies</subject><subject>Sepsis - etiology</subject><subject>Survival Analysis</subject><subject>Transplantation, Homologous</subject><subject>Ventilation</subject><subject>Young Adult</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc2OFCEUhYlx4oyjD-DGEBfuyrlAU1UszWT8SSbRxcyaUNSlm0kVtEBp-lV8Wmmr40QTF-TcwMe5Fw4hrxi8YwDdVQYQijcAqi4mG_GEXLC-ZQ20ij_9U_ebc_I85wcAyUBsnpFzpoQEwcQF-fk14ehtiSnT6CiaNB3oHFMxky8H6gPdm-IxlEx_-LKjxhb_Heu-w7UK5rfERPcp5rLD4i011aBKirFQDGO0Jo2--EyXMGLaRh-2dBfnuE3Glb_ohPvJWJxrxxfkzJkp48uTXpL7Dzd315-a2y8fP1-_v22saFVplOSyZV0_CsOthU51Vo4dSqPE4KBljlluXGf54KxUIJ0aBAqwrWHcDkyIS_J29a0P-LZgLnr22eI0mYBxybrtNrKXXFXwzT_gQ1xSqLPpvmdCCQZ9hdgK2fodOaHT--Rnkw6agT6mptfUdE1NH1PTxwlen4yXYcbx8cYppgrwFcj1KGwxPXb-v-svVRGmiw</recordid><startdate>20090701</startdate><enddate>20090701</enddate><creator>Musci, Michele</creator><creator>Weng, Yuguo</creator><creator>Hübler, Michael</creator><creator>Chavez, Tito</creator><creator>Qedra, Naser</creator><creator>Kosky, Susanne</creator><creator>Stein, Julia</creator><creator>Siniawski, Henryk</creator><creator>Hetzer, Roland</creator><general>D. Steinkopff-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20090701</creationdate><title>Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement</title><author>Musci, Michele ; Weng, Yuguo ; Hübler, Michael ; Chavez, Tito ; Qedra, Naser ; Kosky, Susanne ; Stein, Julia ; Siniawski, Henryk ; Hetzer, Roland</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-95256178d3a2cc0797c5d7e5a93bf061f1c2af7c2bfc5905f9b3e30c6a12cb133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - surgery</topic><topic>Bacterial Infections - epidemiology</topic><topic>Blood Vessel Prosthesis - adverse effects</topic><topic>Blood Vessel Prosthesis - microbiology</topic><topic>Cardiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Endocarditis, Bacterial - microbiology</topic><topic>Endocarditis, Bacterial - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multiple Organ Failure - etiology</topic><topic>Multivariate analysis</topic><topic>Original Paper</topic><topic>Patient Care Team</topic><topic>Predictive Value of Tests</topic><topic>Prostheses</topic><topic>Retrospective Studies</topic><topic>Sepsis - etiology</topic><topic>Survival Analysis</topic><topic>Transplantation, Homologous</topic><topic>Ventilation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Musci, Michele</creatorcontrib><creatorcontrib>Weng, Yuguo</creatorcontrib><creatorcontrib>Hübler, Michael</creatorcontrib><creatorcontrib>Chavez, Tito</creatorcontrib><creatorcontrib>Qedra, Naser</creatorcontrib><creatorcontrib>Kosky, Susanne</creatorcontrib><creatorcontrib>Stein, Julia</creatorcontrib><creatorcontrib>Siniawski, Henryk</creatorcontrib><creatorcontrib>Hetzer, Roland</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Musci, Michele</au><au>Weng, Yuguo</au><au>Hübler, Michael</au><au>Chavez, Tito</au><au>Qedra, Naser</au><au>Kosky, Susanne</au><au>Stein, Julia</au><au>Siniawski, Henryk</au><au>Hetzer, Roland</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2009-07-01</date><risdate>2009</risdate><volume>98</volume><issue>7</issue><spage>443</spage><epage>450</epage><pages>443-450</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><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.</abstract><cop>Heidelberg</cop><pub>D. Steinkopff-Verlag</pub><pmid>19350313</pmid><doi>10.1007/s00392-009-0015-3</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2009-07, Vol.98 (7), p.443-450 |
| issn | 1861-0684 1861-0692 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adolescent Adult Aged Aged, 80 and over Aortic Valve - surgery Bacterial Infections - epidemiology Blood Vessel Prosthesis - adverse effects Blood Vessel Prosthesis - microbiology Cardiology Child Child, Preschool Endocarditis, Bacterial - microbiology Endocarditis, Bacterial - mortality Female Humans Infant Longitudinal Studies Male Medicine Medicine & Public Health Middle Aged Mortality Multiple Organ Failure - etiology Multivariate analysis Original Paper Patient Care Team Predictive Value of Tests Prostheses Retrospective Studies Sepsis - etiology Survival Analysis Transplantation, Homologous Ventilation Young Adult |
| title | Predictors of early mortality in patients with active infective native or prosthetic aortic root endocarditis undergoing homograft aortic root replacement |
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