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Original article
Available online 8 May 2022
Characterization and outcome analysis of cardiac valve surgery for infective endocarditis
Caracterización y análisis de resultados de la cirugía valvular cardiaca por endocarditis infecciosa
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Catarina Sousaa,b,
Corresponding author
catarinasousacardio@gmail.com

Corresponding author.
, Paulo J. Nogueirac, Ricardo Ferreiraa,d, Ângelo Nobrea,d, Fausto J. Pintoa,d
a Centro Cardiovascular da Universidade de Lisboa (CCUL), Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
b Lusíadas Knowledge Center, Lusíadas Saúde, Lisboa, Portugal
c Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Instituto Medicina Preventiva e Saúde Publica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
d Departamento do Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE, Lisboa, Portugal
Received 14 December 2021. Accepted 16 February 2022
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Figures (2)
Tables (4)
Table 1. Baseline characteristics and bivariate analysis of patients hospitalized with incident IE and submitted to surgery in Portugal between 2010 and 2018.
Table 2. Logistic regression analysis of in-hospital surgical management of IE patients in Portugal, from 2010 to 2018.
Table 3. Surgical procedures (absolute value) in IE patients during the index hospitalization (n=937 patients).
Table 4. Logistic regression analysis of in-hospital mortality in patients that underwent surgery.
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Abstract
Introduction and objectives

Evaluating the effect of cardiac valve surgery in the context of infective endocarditis (IE), an uncommon and still deadly disease, can be particularly advantageous in whole-nation population-based studies. It allows a high-volume database analysis with a reduction in the impact of selection bias inherent to single center-based observational studies. The objective was to characterize the profile of patients hospitalized with IE and submitted to cardiac valve surgery, and identify factors associated with in-hospital mortality using a populational-based database.

Methods

A retrospective nationwide observational study of patients hospitalized with IE based on hospital admissions data between 2010 and 2018 in Portugal.

Results

A total of 7574 patients were analyzed (56.9% male; 68.3±17.3 years old). Of these, 937 patients underwent cardiac valve surgery (75.2% men; mean age 61.1±14.7 years old). Single valve intervention was predominant in nearly three quarters of cases. Surgery on the aortic valve was more frequent. Mitral valve repair occurred in 30% of cases. The in-hospital all-cause postoperative mortality rate was 15.6%. Factors associated with in-hospital mortality were female sex, liver, kidney and coronary disease, valve prosthesis, Staphylococcus spp, acute renal failure and sepsis.

Conclusions

This analysis identified factors associated with worse outcome in surgically managed patients with IE in Portugal. Appropriate early identification of surgical stratification markers that may influence the overall prognosis in IE is crucial in the real world clinical setting.

Keywords:
Infective endocarditis
Cardiac surgery
Mortality
Prognosis
Resumen
Introdución y objetivos

Evaluar el efecto de la cirugía valvular cardiaca en el contexto de la endocarditis infecciosa (EI), una enfermedad poco común y aún mortal, puede ser particularmente ventajoso en estudios poblacionales. Permite un análisis de base de datos de gran volumen con una reducción en el impacto del sesgo de selección inherente a los estudios observacionales basados en un solo centro. El objetivo fue caracterizar el perfil de los pacientes hospitalizados por EI tratados con cirugía valvular cardiaca e identificar los factores asociados a la mortalidad intrahospitalaria mediante una base de datos poblacional.

Métodos

Estudio observacional retrospectivo nacional de pacientes hospitalizados con EI basado en datos de ingresos hospitalarios entre 2010 y 2018 en Portugal.

Resultados

Se analizó a 7.574 pacientes (56,9% varones; 68,3±17,3 años). De estos, 937 pacientes se trataron con cirugía valvular cardiaca (75,2% varones; edad media 61,1±14,7 años). La intervención valvular única fue predominante en casi tres cuartas partes de los casos. La cirugía de la válvula aórtica fue más frecuente. La reparación de la válvula mitral ocurrió en el 30% de los casos. La tasa de mortalidad posoperatoria intrahospitalaria por cualquier causa fue del 15,6%. Factores asociados a la mortalidad hospitalaria: sexo femenino, enfermedad hepática, renal y coronaria, prótesis valvulares, Staphylococcus spp., insuficiencia renal aguda y sepsis.

Conclusiones

Este análisis identificó factores asociados con un peor resultado en pacientes con EI tratados quirúrgicamente en Portugal. La identificación temprana adecuada de marcadores de estratificación quirúrgica que pueden influir en el pronóstico general de la EI es crucial en el entorno clínico del mundo real.

Palabras clave:
Endocarditis infecciosa
Cirugía cardiaca
Mortalidad
Pronóstico

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