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South African Medical Journal =... Apr 2022Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in South African retrospective studies ranges... (Observational Study)
Observational Study
Profile, presentation and outcomes of prosthetic valve endocarditis in a South African tertiary hospital: Insights from the Groote Schuur Hospital Infective Endocarditis Registry.
BACKGROUND
Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in South African retrospective studies ranges between 13% and 17%.
OBJECTIVES
To define the clinical profile and outcomes of patients with PVE, and compare them with those of native valve endocarditis (NVE) patients.
METHODS
We performed a prospective observational study of patients presenting or referred to Groote Schuur Hospital, Cape Town, with definite or possible infective endocarditis (IE) based on the 2015 European Society of Cardiology IE diagnostic criteria. Consenting adult patients who met the inclusion criteria were enrolled into the Groote Schuur Hospital Infective Endocarditis Registry, which was approved by the University of Cape Town Human Research Ethics Committee. This study is an analysis of the patients enrolled between 1 January 2017 and 31 December 2019.
RESULTS
During the study period, a total of 135 patients received a diagnosis of possible or definite IE (PVE n=18, NVE n=117). PVE therefore accounted for 13.3% of the overall IE cohort. PVE patients had a mean (standard deviation) age of 39.1 (14.6) years, and 56.6% were male. PVE occurred within 1 year of valve surgery in 50.0% of cases. Duke's modified diagnostic criteria for definite IE were met in 94.4% of the PVE cohort. Isolated aortic valve PVE was present in 33.3%, and a combination of aortic and mitral valve PVE in 66.6%. Tissue prosthetic valves were affected in 61.1% of cases. Of the PVE cases, 55.6% were healthcare associated. On transthoracic echocardiography, vegetations (61.1%), prosthetic valve regurgitation (44.4%) and abscesses (22.2%) were discovered. Staphylococcus and Streptococcus species accounted for 38.8% and 22.2% of PVE cases, respectively, and 27.8% of cases were blood culture negative. Valve surgery was performed in 38.7% of the PVE patients, and 55.6% of the patients died during the index hospitalisation. Secondary analysis indicated that the PVE patients were sicker than those with NVE, with a higher frequency of septic shock and atrioventricular block (22.2% v. 7%; p=0.02 and 27.8% v. 12%; p=0.04, respectively). In addition, in-hospital mortality was higher in PVE patients than NVE patients (55.6% v. 31.6%; p=0.04).
CONCLUSIONS
PVE was uncommon, mainly affecting tissue prosthetic valves and prosthetic valves in the aortic position. Patients with PVE were sicker than those with NVE and had high in-hospital mortality.
Topics: Adult; Endocarditis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Hospital Mortality; Humans; Male; Prosthesis-Related Infections; Registries; Retrospective Studies; South Africa; Tertiary Care Centers
PubMed: 35587808
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Dec 2021Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially... (Review)
Review
Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.
Topics: Echocardiography; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans
PubMed: 35056331
DOI: 10.3390/medicina58010023 -
Anatolian Journal of Cardiology Sep 2022Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve replacement. This study aimed to describe the clinical features and...
BACKGROUND
Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve replacement. This study aimed to describe the clinical features and etiologic causes of patients with intermittent mechanical prosthetic heart valve dysfunction.
METHODS
Between 2010 and 2021, 16 patients who were evaluated in the echocardiography laboratory of Koşuyolu Training and Research Hospital with the diagnosis of intermittent malfunction of prosthetic valves were included in the study.
RESULTS
The evaluated patients consisted of 12 bi-leaflet mitral valve replacements and 2 mono-leaflet mitral valve replacements. The underlying causes of intermittent malfunction were classified as follows: residual chord (n=4), obstructive thrombus (n=2), non-obstructive thrombus (n=2), vegetation (n=2), pannus and obstructive thrombus coexistence (n=1), and solely pannus (n=1). One of the patients with mono-leaflet mitral valve replacements had pannus and obstructive thrombus. In the other patient with mono-leaflet mitral valve replacement, a stuck valve was observed in 1 of 12 beats secondary to arrhythmia. There were also 2 patients with aortic valve replacements. One patient had moderate aortic regurgitation due to prominent calcification and the other had moderate obstruction due to pannus. In the patient with pannus, a stuck leaflet was observed in 1 of 6 beats and moderate aortic regurgitation arose in 1 of 2 beats in the patient with calcification.
CONCLUSIONS
The intermittent stuck valve may have catastrophic outcomes. When making a treatment decision in these patients, assessing the degree of regurgitation or stenosis is essential. In particular, the frequency of entrapment should be taken into consideration when deciding the optimal therapy for intermittent prosthetic heart valve dysfunction.
Topics: Aortic Valve; Aortic Valve Insufficiency; Calcinosis; Heart Valve Prosthesis; Humans; Prosthesis Failure; Thrombosis
PubMed: 35949129
DOI: 10.5152/AnatolJCardiol.2022.1677 -
Journal of Cardiac Surgery Dec 2020The hemodynamic effect and early and late survival impact of prosthesis-patient mismatch (PPM) after mitral valve replacement remains insufficiently explored. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The hemodynamic effect and early and late survival impact of prosthesis-patient mismatch (PPM) after mitral valve replacement remains insufficiently explored.
METHODS
Pubmed, Embase, Web of Science, and Cochrane Library databases were searched for English language original publications. The search yielded 791 potentially relevant studies. The final review and analysis included 19 studies compromising 11,675 patients.
RESULTS
Prosthetic effective orifice area was calculated with the continuity equation method in 7 (37%), pressure half-time method in 2 (10%), and partially or fully obtained from referenced values in 10 (53%) studies. Risk factors for PPM included gender (male), diabetes mellitus, chronic renal disease, and the use of bioprostheses. When pooling unadjusted data, PPM was associated with higher perioperative (odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.32-2.10; p < .001) and late mortality (hazard ratio [HR]: 1.46; 95% CI: 1.21-1.77; p < .001). Moreover, PPM was associated with higher late mortality when Cox proportional-hazards regression (HR: 1.97; 95% CI: 1.57-2.47; p < .001) and propensity score (HR: 1.99; 95% CI: 1.34-2.95; p < .001) adjusted data were pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84-1.22; p = .88) or severe (HR: 1.19; 95% CI: 0.89-1.58; p = .24) PPM were not related to higher late mortality when adjusted data were pooled individually. PPM was associated with higher systolic pulmonary pressures (mean difference: 7.88 mmHg; 95% CI: 4.72-11.05; p < .001) and less pulmonary hypertension regression (OR: 5.78; 95% CI: 3.33-10.05; p < .001) late after surgery.
CONCLUSIONS
Mitral valve PPM is associated with higher postoperative pulmonary artery pressure and might impair perioperative and overall survival. The relation should be further assessed in properly designed studies.
Topics: Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Risk Factors; Treatment Outcome
PubMed: 33085138
DOI: 10.1111/jocs.15108 -
Brazilian Journal of Cardiovascular... Oct 2022Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement. An easy and quickly applicable diagnostic procedure is required for...
INTRODUCTION
Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement. An easy and quickly applicable diagnostic procedure is required for recognizing the prosthetic valve dysfunction. The purpose of this study was to prospectively define the diagnostic value of D-dimer and INR level in predicting prosthetic valve dysfunction.
METHODS
This cross-sectional study was performed in 70 patients suspected to have prosthetic valve dysfunction admitted to Imam Ali Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. Cinefluoroscopy, as the gold standard diagnostic test, was used for the diagnosis of prosthetic valve dysfunction in enrolled patients. Two milliliters of blood from each patient were taken into a tube containing sodium citrate anticoagulant. To evaluate D-dimer, the cutoff value was set at 500 ng/ml. Also, to evaluate international normalized ratio (INR), the cutoff value was set at 2. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the serum markers were used to describe predictive properties.
RESULTS
Of 70 patients, 27 (38.6%) were male and 43 (61.4%) were female, and the mean age was 54.67±15.11 years (range, 18 to 80 years). Of 70 patients, 27 (38.6%) had prosthetic heart valve malfunction demonstrable by fluoroscopy, and 19 patients (27.1%) had D-dimer levels >500 ng/ml. Elevated D-dimer levels (>500 ng/ml) have been indicated to have sensitivity of 70.4%, and hence an NPV of 84.3%, specificity of 100%, PPV of 100%, NLR of 0.3, and the infinity value of PLR for predicting prosthetic valve dysfunction. There was a significant relationship between fluoroscopy and D-dimer test (P=0.001). A kappa coefficient value of 0.745 indicated a substantial agreement between D-dimer and fluoroscopy testing. Mixing test (combination of D-dimer and INR) showed to have 100% sensitivity, and hence a NPV of 69.8%, specificity of 69.8%, PPV of 51.8%, NLR of 1.41, and PLR of 1.44 for predicting prosthetic valve dysfunction.
CONCLUSION
D-dimer with moderate sensitivity and high specificity is an ideal marker for the diagnosis of prosthetic valve dysfunction in suspected patients. Enhanced plasma D-dimer level is not by itself diagnostic of a prosthetic valve dysfunction but may alert physicians to refer the patient for more detailed examination, preferably by fluoroscopy. Mixing test with 100% sensitivity can apply as a rule-out test.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Cross-Sectional Studies; Fibrin Fibrinogen Degradation Products; Heart Valve Prosthesis; International Normalized Ratio; Predictive Value of Tests; Sensitivity and Specificity; Adolescent; Young Adult; Aged, 80 and over
PubMed: 35244382
DOI: 10.21470/1678-9741-2021-0230 -
The Journal of Invasive Cardiology Jun 2022Data are lacking regarding the outcomes of balloon postdilation (BPD) for the Acurate neo and neo2 devices. The aim of this study was to assess the impact of BPD in a...
BACKGROUND
Data are lacking regarding the outcomes of balloon postdilation (BPD) for the Acurate neo and neo2 devices. The aim of this study was to assess the impact of BPD in a large, single-center cohort of patients treated with the Acurate platform.
METHODS
For this retrospective analysis, we included all patients with severe aortic stenosis who underwent transfemoral transcatheter aortic valve replacement (TAVR) with the Acurate neo or neo2 prosthesis at our institution.
RESULTS
Among 1417 Acurate recipients, BPD was required in 521 cases (36.8%) for relevant paravalvular regurgitation (PVR) (n = 418) and incomplete prosthesis expansion or increased transprosthetic gradients (n = 103). Overall, BPD was successful in 87.9% and led to a significant reduction of more-than-mild PVR from 32.0% to 7.5% (P<.001). In the BPD group, prosthesis-patient mismatch (PPM) was less common. Prosthetic leaflet damage or valve dislodgment due to BPD occurred in 6 cases (1.2%). All other outcomes were similar between groups with and without BPD, including rates of aortic root injury, stroke, acute kidney injury, permanent pacemaker implantation, and all-cause 30-day mortality. Independent predictors of the need for BPD were higher mean transaortic gradients, severe aortic valve calcification, less prosthesis oversizing, and the use of larger prosthesis sizes.
CONCLUSION
For transfemoral TAVR using the Acurate neo/neo2, BPD effectively reduces relevant PVR and decreases the risk of PPM without increasing adverse events. Transcatheter heart valve damage associated with BPD is rare, commonly avoidable, and does not jeopardize the net benefit of BPD.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Prosthesis Design; Retrospective Studies; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35593542
DOI: No ID Found -
Texas Heart Institute Journal Mar 2022Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken...
Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses.
Topics: Aortic Valve; Cardiac Surgical Procedures; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Prosthesis Design; Reproducibility of Results
PubMed: 35390164
DOI: 10.14503/THIJ-20-7267 -
JAMA Network Open Jul 2023It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed...
IMPORTANCE
It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement.
OBJECTIVE
To assess the clinical characteristics and outcomes of patients with C acnes endocarditis.
DESIGN, SETTING, AND PARTICIPANTS
A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for C acnes, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022.
MAIN OUTCOMES AND MEASURES
Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates.
RESULTS
A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg/dL (IQR, 1.2-7.5 mg/dL), and the median leukocyte count was 10.0 × 103/µL (IQR, 8.2-12.2 × 103/µL). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]).
CONCLUSIONS AND RELEVANCE
This case series suggests that C acnes endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing C acnes endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.
Topics: Humans; Male; Middle Aged; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Communicable Diseases; Electrocardiography
PubMed: 37436747
DOI: 10.1001/jamanetworkopen.2023.23112 -
Annals of Cardiac Anaesthesia 2021We looked for a correlation between the surgically measured mitral valve size and the cardiac dimensions (left ventricle internal diameter, left atrial size, aorta size,...
OBJECTIVE
We looked for a correlation between the surgically measured mitral valve size and the cardiac dimensions (left ventricle internal diameter, left atrial size, aorta size, and body surface area) measured by preoperative and intraoperative echocardiography. We also assessed to see if we could predict the mitral prosthesis size based on the correlation data obtained.
METHODS
The hospital records of 180 patients who underwent mitral valve replacement (MVR) with TTK Chitra valve between January 2008 and December 2012 at our hospital, were studied. The correlation between surgically measured mitral annulus size to left ventricular internal diameter systolic (LVIDS) and diastolic (LVIDD), left atrial size (linear measurement), and aorta size on echocardiography and body surface area was calculated using Pearson correlation coefficient. Mean LVIDS was calculated for each valve prosthesis size separately and the correlation was studied.
RESULTS
The correlation between mitral valve prosthesis size and left ventricular internal diameter (systolic) showed a Pearson coefficient of 3.3 with significance at the level 0.01. Mitral valve size and left atrial size showed a correlation coefficient of 2.7 with significance at the level 0.01. The correlation coefficient for mitral valve size with left ventricular internal diameter diastolic, aorta and body surface area were 2.5, 1.9, and 1.8, respectively. There was a gradual increase in the mean LVIDS with increase in the prosthetic valve size. Box plot and scatter plot showed linear correlation between valve size and mean LVIDS.
Topics: Echocardiography; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 34269261
DOI: 10.4103/aca.ACA_91_20 -
Journal of Cardiothoracic Surgery Aug 2021Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic...
BACKGROUND
Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM.
OBJECTIVES
To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM.
METHODS
From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson's correlation coefficient. Univariable linear regression was then used to build the predictive model.
RESULTS
A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter.
CONCLUSIONS
Preoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.
Topics: Adult; Aged; Aortic Valve; Aortic Valve Stenosis; Diabetes Mellitus, Type 2; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Multidetector Computed Tomography; Prosthesis Design
PubMed: 34348752
DOI: 10.1186/s13019-021-01601-z