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PloS One 2023Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment.
BACKGROUND
Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment.
METHODS
Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed.
RESULTS
The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke.
CONCLUSIONS
Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
Topics: Humans; Male; Middle Aged; Aged; Female; Prognosis; Endocarditis, Bacterial; Heart Valve Prosthesis; Shock, Septic; Endocarditis; Registries
PubMed: 37682961
DOI: 10.1371/journal.pone.0290998 -
Circulation. Cardiovascular Imaging Jul 2020Multimodality imaging plays a pivotal role in the evaluation and management of infective endocarditis (IE)-a condition with high morbidity and mortality. The diagnosis... (Review)
Review
Multimodality imaging plays a pivotal role in the evaluation and management of infective endocarditis (IE)-a condition with high morbidity and mortality. The diagnosis of IE is primarily based on the modified Duke criteria with echocardiography as the first-line imaging modality. Both transthoracic and transesophageal echocardiography delineate vegetation location and size, assess for paravalvular extension of infection, and have the added advantage of defining the hemodynamic effects of valvular or device infection. Native and prosthetic valve IE, infections relating to cardiac implantable electronic devices, and indwelling catheters are effectively evaluated with echocardiography. However, complementary imaging is occasionally required when there remains diagnostic uncertainty following transesophageal echocardiography. Multidetector computed tomography and nuclear imaging techniques such as positron emission tomography and white blood cell scintigraphy have been shown to reduce the rate of misdiagnosed IE particularly in the setting of prosthetic valve endocarditis, paravalvular extension of infection, and cardiac implantable electronic devices. In this review, we describe a modern approach to cardiac imaging in native and prosthetic valve endocarditis, as well as cardiac implantable electronic devices including pacing devices and left ventricular assist devices. Current guidelines addressing the role of multimodality imaging in IE are discussed. The utility of imaging in the assessment of local and distant endocarditis complications such as pericardial sequelae, myocarditis, and embolic events is also addressed.
Topics: Cardiac Imaging Techniques; Clinical Decision-Making; Defibrillators, Implantable; Endocarditis; Heart Valve Prosthesis; Heart-Assist Devices; Humans; Multimodal Imaging; Pacemaker, Artificial; Predictive Value of Tests; Prognosis; Prosthesis-Related Infections; Risk Factors
PubMed: 32683888
DOI: 10.1161/CIRCIMAGING.120.008956 -
JACC. Cardiovascular Imaging Dec 2020
Topics: Endocarditis; Endocarditis, Bacterial; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Reference Standards; Uncertainty
PubMed: 32828768
DOI: 10.1016/j.jcmg.2020.06.023 -
International Journal of Cardiology Nov 2020Rheumatic heart disease (RHD) still affects more patients globally than degenerative valve disease. The vast majority of these patients live in low- to middle-income... (Review)
Review
Rheumatic heart disease (RHD) still affects more patients globally than degenerative valve disease. The vast majority of these patients live in low- to middle-income countries. Once symptomatic, they will need heart valve surgery. Unfortunately, prosthetic valves perform poorly in these patients given their young age, the high incidence of multi-valve disease, late diagnoses and often challenging socio-economic circumstances. Notwithstanding the fact that better valve designs would ideally be available, ill-informed decision making processes between bioprosthetic and mechanical valves are contributing to the poor results. In the absence of multicentred, randomised clinical trials, comparing the current generations of bioprostheses with mechanical valves across all age groups Western guidelines tend to be uncritically applied. As a consequence, mechanical valves are being implanted into patients who are often not able to deal with anticoagulation while bioprosthetic valves may be overly shunned for fear of reoperations. Almost sixty years after the advent of cardiac surgery heart valve prostheses have eventually undergone improvements and several potentially disruptive developments are on the horizon. Until they materialise, however, choices between contemporary valve prostheses need to be made on the basis of individual risk and life-expectancy rather than an uncritical implementation of guidelines that were derived for very different patients and under distinctly different conditions. Given the fast expansion of cardiac surgery in middle-income countries and a growing number of independently operating centres in low-income countries a critical appraisal of facts underlying the choice of heart valve prostheses for patients with RHD seems opportune.
Topics: Bioprosthesis; Cardiac Surgical Procedures; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Reoperation; Rheumatic Heart Disease
PubMed: 32464247
DOI: 10.1016/j.ijcard.2020.05.073 -
Current Opinion in Infectious Diseases Dec 2021Current evidence on cardiovascular infections in Gram-negative blood stream infections (GNBSI) with focus on the use of transesophageal echocardiography (TEE) and... (Review)
Review
PURPOSE OF REVIEW
Current evidence on cardiovascular infections in Gram-negative blood stream infections (GNBSI) with focus on the use of transesophageal echocardiography (TEE) and 18F-Fluorodeoxyglucose - positron emission tomography/Computed tomography (FDG-PET/CT) in the diagnostic workup.
RECENT FINDINGS
Most evidence focuses on characteristics of diagnosed cardiovascular infections and the proportion caused by GNBSI. These proportions are low (1-5%) when it comes to native and prosthetic valve endocarditis as well as cardiac implantable electronic device (CIED) infections whereas the proportion of vascular graft infections caused by GNBSI seems substantially higher (30-40%). Information on the prevalence of cardiovascular infection in patients with GNBSI is limited to a few studies finding around 3% endocarditis in patients with GNBSI and a prosthetic heart valve and 4-16% device-related infection in patients with CIED and GNBSI.
SUMMARY
Patients with GNBSI and native or prosthetic valves should only undergo work-up for endocarditis (TEE and FDG-PET/CT) if they present GNBSI relapse or signs suggestive of endocarditis. CIED patients with GNBSI with Pseudomonas or Serratia spp. should undergo TEE and PET/CT because of the high prevalence of device-related infection. In other GNBs without IE suggestive signs, normal BSI treatment is reasonable and only cases with relapse need work-up. GNBSI in patients with vascular grafts should lead to consideration of PET/CT.
Topics: Bacteremia; Echocardiography; Endocarditis; Endocarditis, Bacterial; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 34751186
DOI: 10.1097/QCO.0000000000000781 -
Multimedia Manual of Cardiothoracic... Apr 2023Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with...
Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with mitral and tricuspid procedures, aortic valve operations increase the challenge for several reasons. If one relies only on the thoracoscope, the surgical planning and set-up, including the placement of the working port and technical surgical manoeuvres like the aortic cross-clamp, the aortotomy and the aortorrhaphy can be difficult and may lead to severe complications or an increased rate of conversion to sternotomy. A well-developed preoperative decision-making process that includes knowledge of the prosthetic valve characteristics and their implications in an endoscopic environment is crucial for a successful endoscopic aortic valve programme. This video tutorial provides tips and tricks useful for endoscopic aortic valve replacement by paying attention to the patient's anatomy, to the available prosthetic valve types and to their impact on the surgical set-up.
Topics: Humans; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Endoscopy; Minimally Invasive Surgical Procedures
PubMed: 37009910
DOI: 10.1510/mmcts.2023.007 -
Journal of Cardiac Surgery Sep 2022Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication. Surgery and fibrinolytic therapy (FT) are the two main treatment options for PVT. The choice between surgery and FT has always been a matter of debate. Previous studies have shown that although the mortality rate is higher in surgery, complications are less frequent than in FT. We aimed to perform a systematic review and meta-analysis to compare the results of surgery and FT in PVT.
METHODS
A systematic review of the literature was performed through Medline, Embase, Scopus, and Web of Science, encompassing all studies comparing surgery and FT in PVT. The rate of each complication and risk ratio (RR) of complications in surgery and FT were assessed using random-effects models.
RESULTS
Fifteen studies with 1235 patients were included in the meta-analysis. The pooled risk of the mortality was not significantly different between FT and surgery in patients with PVT (pooled RR = 0.78, 95% confidence interval [CI]: 0.38-1.60, I² = 61.4%). The pooled risks of thromboembolic events (pooled RR = 4.70, 95% CI: 1.83-12.07, I² = 49.6%) and major bleeding (pooled RR = 2.45, 95% CI: 1.09-5.50, I² = 41.1%) and PVT recurrence (pooled RR = 2.06 95% CI: 1.29-3.27, I² = 0.0%) were significantly higher in patients who received FT.
CONCLUSION
Surgery may be safer and with fewer complications than FT for PVT treatment. However, randomized clinical trials are needed to determine the proper treatment for PVT.
Topics: Fibrinolytic Agents; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombolytic Therapy; Thrombosis
PubMed: 35701901
DOI: 10.1111/jocs.16681 -
Current Cardiology Reports Jul 2020The clinical and incremental value of functional imaging with F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis and... (Review)
Review
PURPOSE OF REVIEW
The clinical and incremental value of functional imaging with F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis and management of patients with suspected native and prosthetic valve infective endocarditis (IE).
RECENT FINDINGS
The diagnosis of IE is challenging because of the highly variable clinical presentations, especially in the case of prosthetic valve endocarditis (PVE). FDG PET/CT has been shown to play an important role for the diagnosis of PVE as a major Duke criterion. Whether FDG PET/CT could play a similar role in patients with suspected native valve endocarditis (NVE) is less well established. It is increasingly recognized that IE is a multisystem disorder, and identification of extra-cardiac manifestations on whole-body FDG PET/CT impacts management and prognosis of patients with IE. Finally, FDG PET/CT provides incremental prognostic value over other clinical and para-clinical parameters, enabling prediction of in-hospital mortality, IE recurrence, hospitalization, and new onset heart failure and embolic events. FDG PET/CT plays a key role in the investigation of patients with suspected IE, enabling detection of valvular infection and extra-cardiac manifestations of the infection which has important prognostic implications.
Topics: Endocarditis; Endocarditis, Bacterial; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Prosthesis-Related Infections; Radiopharmaceuticals
PubMed: 32647931
DOI: 10.1007/s11886-020-01334-w -
Expert Review of Medical Devices Mar 2020: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there... (Review)
Review
: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.: The etiopathogenesis, diagnosis, and management of prosthetic heart valve thrombosis with particular focus on conventional and esoteric predisposing factors, diagnosis with multimodality imaging and current therapeutic approaches were covered.: Subtherapeutic anticoagulation remains the key driving force for the development of prosthetic valve thrombosis. However, cardiologists should be cognizant of other frequent or rare conventional and esoteric causes. The diagnosis is now more straightforward with the use of multimodality imaging. Transthoracic and transesophageal echocardiography with or without real-time three-dimensional imaging are the current gold standard modalities. Multidetector computed tomography is now a major complementary tool. The favorable clinical outcomes with recently introduced slow or ultra-slow infusions of alteplase, as compared to relatively poor surgical results, have rendered thrombolytic therapy the first-line treatment option in most eligible patients with prosthetic valve thrombosis. Surgical treatment could be reserved in whom thrombolytic therapy is contraindicated or has already failed. The efficacy and safety of thrombolytic therapy as compared to surgery should be confirmed with large observational cohorts, and ideally randomized trials.
Topics: Echocardiography, Transesophageal; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator
PubMed: 32085683
DOI: 10.1080/17434440.2020.1733972 -
Journal of Cardiac Surgery May 2022Surgical aortic valve replacement (sAVR) remains one of the most common cardiac operations performed globally on an annual basis. Biological and mechanical valves...
Surgical aortic valve replacement (sAVR) remains one of the most common cardiac operations performed globally on an annual basis. Biological and mechanical valves comprise the two classes of prosthetic valves available to surgeons. Biological prosthetic valves can be prone to failure and structural valve deterioration (SVD), which may necessitate reintervention. Recent literature suggests that the Trifecta heart valve is susceptible to early failure. In this retrospective study, Yount et al. use institutional data to assess the longevity of the Trifecta heart valve. The investigators included patients who had undergone sAVR and had received either a Trifecta prosthetic heart valve or a Magna/Magna Ease heart valve. While there were some baseline differences between the patient groups, the study found that those who had received a Trifecta valve had higher rates of valve failure. This is an important study that adds valuable evidence pertaining to the incidence of failure and SVD with the Trifecta heart valve. Although further studies may shed light on the precise mechanisms that drive valve failure and deterioration, surgeons should be aware of the mounting clinical data in this area.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Retrospective Studies; Treatment Outcome
PubMed: 35152477
DOI: 10.1111/jocs.16325