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Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry
- Source :
- European Journal of Cardio-Thoracic Surgery, 58(4), 839-846. Oxford University Press
- Publication Year :
- 2020
-
Abstract
- OBJECTIVES Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis. METHODS Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 ± 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%. RESULTS Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30 months (1–221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9–219)]. Survival at 5 and 8 years was 75 ± 6% and 71 ± 7%, with 3 cases of endocarditis relapse. CONCLUSIONS Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.
- Subjects :
- Aortic valve
Male
Bentall procedure
030204 cardiovascular system & hematology
AORTIC ROOT REPLACEMENT
0302 clinical medicine
Mitral valve
Aortic root
Registries
Heart Valve Prosthesis Implantation
Endocarditis
Hazard ratio
General Medicine
Middle Aged
Mediastinitis
medicine.anatomical_structure
Treatment Outcome
Heart Valve Prosthesis
SURGICAL-TREATMENT
Female
Cardiology and Cardiovascular Medicine
Aortic surgery
Adult
Aged
Aortic Valve
Humans
Reoperation
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Preoperative care
03 medical and health sciences
medicine
MANAGEMENT
INFECTIVE ENDOCARDITIS
TERM-FOLLOW-UP
business.industry
GRAFT
Perioperative
medicine.disease
Surgery
030228 respiratory system
PROSTHETIC VALVE ENDOCARDITIS
ASCENDING AORTA
business
Subjects
Details
- Language :
- English
- ISSN :
- 10107940
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery, 58(4), 839-846. Oxford University Press
- Accession number :
- edsair.doi.dedup.....17d30035e07a78bfb5b41d2149a7d83f