Endocarditis en pacientes con una prótesis en aorta ascendente: estudio de una serie del registro multicéntrico nacional
Publicada esta importante serie en la que tenemos el honor de participar.
Antonio Ramosa,*, Carlos García-Monterob, Alfonso Morenoc, Patricia Muñozd,e, Josefa Ruiz-Moralesf, Gemma Sánchez-Espíng, Carlos Porrasg, Dolores Sousah, Laura Casteloh, María del Carmen Fariñasi, Francisco Gutiérrezj, José María Reguerak, Antonio Platak, Emilio Bouzal,m, Isabel Antorrenan, Arístides de Alarcóno, José Manuel Pericásp, Mercedes Gurguíq, Hugo Rodríguez-Abellar, Miguel Ángel Goenagas, José Antonio Oteot and Pablo García-Pavíau
a Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain b Department of Heart Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain c Department of Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain d Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Maranon, Madrid, Spain e Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain f Department of Infectious Diseases UGC, Hospital Universitario Virgen de la Victoria, Málaga, Spain g Department of Heart Surgery UGC, Hospital Universitario Virgen de la Victoria, Málaga, Spain h Department of Infectious Diseases, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain i Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain j Department of Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain k Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain i Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain m Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain n Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain o Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain p Department of Infectious Diseases, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain q Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain r Department of Heart Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain s Department of Infectious Diseases, Hospital Universitario Donosti, San Sebastián, Spain t Department of Infectious Diseases, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Madrid, Spain u Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
OBJECTIVES Endocarditis in patients with ascending aortic prosthetic graft (AAPG) is a life-threatening complication. The purpose of this study was to examine the clinical presentation and prognosis of patients with AAPG endocarditis included in a large prospective infectious endocarditis multicentre study.
METHODS From January 2008 to April 2015, 3200 consecutive patients with infectious endocarditis according to the modified Duke criteria, were prospectively included in the ‘Spanish Collaboration on Endocarditis Registry (GAMES)’ registry. Twenty-seven definite episodes of endocarditis (0.8%) occurred in patients with AAPG.
RESULTS During the study period, 27 cases of endocarditis were detected in patients with AAPG. The median age of patients was 61 years [interquartile range (IQR) 51–68 years] and 23 (85.2%) patients were male. The median time from AAPG surgery to the episode of AAPG infection was 24 months (IQR 6–108 months). The most frequently isolated micro-organisms were coagulase-negative staphylococci and S. aureus (11 patients, 40.7%). Four patients (14.8%) underwent medical treatment, whereas surgery was performed in 21 (77.7%). Two patients (7.4%) died before surgery could be performed. The median hospital stay prior to surgery was 7 days (IQR 4–21 days). Surgery consisted of replacing previous grafts with a composite aortic graft (10 cases) or aortic homograft (2 patients), and removal of a large vegetation attached to the valve of a composite tube (1 case). Nine patients had an infected aortic valve prosthesis without evidence of involvement of the AAPG. Isolated redo-aortic valve replacement was performed in 8 (88.9%) of these patients. Reinfection occurring during 1 year of follow-up was not detected in any patient. Two patients (7.4%) died while awaiting surgery and 6 did so after surgery (22.2%). A New York Heart Association (NYHA) Class IV was associated with mortality in patients undergoing surgery (P < 0.019).
CONCLUSIONS Most cases of endocarditis in patients with AAPG occur late after initial surgery. Mortality rate of patients with AAPG endocarditis who undergo surgery is acceptable. NYHA Class IV before surgery is associated with an increased postoperative mortality.