Initial Strategy for Aortic Valve Endocarditis Complicated with Heart Failure

Ryohei Matsuura, Koichi Toda, Daisuke Yoshioka, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Shunsuke Saito, Keitaro Domae, Takayoshi Ueno, Toru Kuratani, Yoshiki Sawa

Department of Cardiovascular Surgery, Osaka University Graduate school of medicine, Suita, Japan

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Objectives: Several guidelines recommend early surgery for infective endocarditis (IE) with acute heart failure (AHF), although the clinical results are little known. We investigated the impact of initial treatment for IE in the aortic valve position complicated with heart failure.

Methods: We retrospectively investigated 470 patients with active IE, who underwent valve surgery between 2009 and 2016. Of these,67 patients had symptomatic AHF at the time of IE diagnosis infected at aortic valve alone (The patients with cardiogenic shock or those intubated for AHF were excluded), and we divided these patients into 2 groups, according to the initial treatment; those who underwent valve surgery as soon as possible (group-S: n=30), and those who were initially given medical treatment for infection and HF (group-A: n=37). The characteristics of patients and results were compared.

Results: The average age was 65±3 vs 63±3 years old (p=0.72) and the median waiting period from diagnosis to surgery was 1.5(0–3) vs 15(7–44) days (p<0.01) for group-S and group-A, respectively.The preoperative blood culture positive rate was 67% vs 65% (p=0.88). The maximum vegetation diameter was 12.6±6.8 mm vs 10.6±5.9 (p=0.27); EF, 59% vs 64% (p=0.81). Surgeries were performed in a single AVR, 20 cases vs 18 cases (69% vs 49%); vegetectomy, 1 case vs 0 cases (3% vs 0%); annuloplasty, 6 cases vs 14 cases (21% vs 39%); aortic root replacement, 3 vs 5 cases (10% vs 14%) (p=0.23). Surgery time was 340 ± 159 vs 444 ± 207 min (p<0.01), hospital death was observed in 0 cases vs 8 cases (22%, MOF, 1 case; infection, 1 case; respiratory failure, 1 case) (p<0.01). One year survival rate was 86% vs 68% (p=0.02).

Conclusions: Considering poor outcomes of emergent surgery for medically refractory HF, early surgery may be reasonable option for aortic valve endocarditis patients.