Aortic Valve Endocarditis Research Articles

Case Report and Literature Review of Exophiala dermatitidis Fungal Endocarditis in a Prosthetic Aortic Valve

Abstract Prosthetic valve endocarditis is a rare complication following surgical aortic valve replacement, accounting for a small fraction of all endocarditis cases. This complication is typically caused by bacterial pathogens and carries a high mortality rate. In rare cases, prosthetic valve endocarditis may be attributed to fungal organisms. We present the case of a 47-year-old woman who developed prosthetic valve endocarditis from a fungus known as Exophiala dermatitidis. Prosthetic valve endocarditis caused by this pathogen is extremely rare, with only 3 previously reported cases of prosthetic valve endocarditis attributed to this fungus since 1969. Review of the previous literature revealed an additional 3 cases originating in native aortic valves. These cases tended to occur in relatively young patients and those with risk factors for infective endocarditis such as immunosuppression and intravenous drug use. Septic emboli to various organs, particularly the brain and spleen, appear to be a complication of fungal endocarditis caused by this organism. Management can be difficult due to the lack of guidelines to treat such rare infective complications, but replacement of the infected valve and a prolonged course of antifungal therapy appear to be effective in some cases.

Recurrent Systemic Embolization From Bicuspid Aortic Valve Endocarditis in the Setting of Anti-coagulation Use

Recurrent Systemic Embolization From Bicuspid Aortic Valve Endocarditis in the Setting of Anti-coagulation Use

Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.

This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring. We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients. The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed. The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

A mitral valve aneurysm: A rare complication of aortic valve endocarditis

A mitral valve aneurysm: A rare complication of aortic valve endocarditis

Aortic Homografts in Surgical Management of Prosthetic Valve Endocarditis: A Case Series from Greece.

BACKGROUND Infective endocarditis (IE) is a severe, life-threatening, and relatively common complication after valve replacement operations, with incidence rates varying between 1.8% and 5.8%, with an in-hospital mortality rate of up to 20%. Common microorganisms are (listed by decreasing incidence) Streptococci, Staphylococcus aureus, Enterococci, bacteria of the HACEK group, and fungi. Treatment of IE is complex, typically involving prolonged courses of antibiotics. However, in cases of aortic prosthetic valve endocarditis, root abscess formation with involvement of the aorto-mitral skeleton is not uncommon and complex surgical intervention is required. One of the notable advancements in surgical management is the use of homografts for aortic root endocarditis. CASE REPORT We report the first case series of 8 patients successfully operated on for prosthetic valve endocarditis with extensive aortic root abscess formation in Greece at Onassis Cardiac Surgery Center with the use of aortic homograft. All cases were redo surgeries and had good outcomes. Interestingly, one of the cases had extensive aortic root involvement with abscess formation extending to the aorto-mitral fibrous skeleton, requiring aortic root replacement with homograft, aorto-mitral skeleton reconstruction with bovine pericardium and mitral valve replacement with a mechanical prosthesis. Two other patients required concomitant coronary bypass grafting of the right coronary artery with reversed saphenous vein grafts. CONCLUSIONS Aortic root replacement with aortic homograft is the preferred choice for prosthetic valve endocarditis with aortic root abscess formation. Despite the technical complexity needed for implantation, this option offers a second chance for survival in patients with this challenging condition.

Aneurysm of the Anterior Mitral Valve Complicating Infectious Mitro-Aortic Endocarditis in a Biscuspid Aortic Valve: About a Case

Mitral valve aneurysm is a rare condition usually associated with aortic valve endocarditis. The mechanism, poorly understood, generally includes a regurgitant infectious flow originating from the aortic valve, direct contact with vegetation and direct propagation, through adjacent structures, such as the mitro-aortic intervalvular fibrous body. This report details the case of a 56-year-old patient followed for severe bicuspid aortic insufficiency of the aortic valve for 4 months and admitted to heart failure due to infectious endocarditis with a fatal outcome. Physical examination revealed aortic and mitral insufficiency syndrome and congestive heart failure. Transthoracic echocardiography revealed type 1 L-R bicuspid heart disease and leaking polyvalvulopathy with severe eccentric aortic and severe mitral regurgitation. The aortic and mitral valves were the seat of the vegetations. The mitral valve was the seat on its atrial side of a contained aneurysmal sac with thrombosed hyperechogenicity. Blood cultures were positive for streptococci and probabilistic dual antibiotic therapy was started. The patient was unable to benefit from surgical treatment. However, the patient died following complications such as ischemic stroke and septic shock. A necropsy was not done.

Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials

Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score <4%) (PROSPERO ID: CRD42023480495). Primary outcome analyzed was all-cause death at a minimum of 3 years of follow-up. The secondary outcomes were cardiovascular death, disabling stroke, myocardial infarction, aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation, and bioprosthetic valve failure. A total of 3 randomized clinical trials with 2,644 patients (TAVR n = 1,371 patients; SAVR n = 1,273 patients) were included. The follow-up time was 6 ± 2.9 years. TAVR resulted noninferior to SAVR for all-cause death (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.84 to 1.17, p = 0.89, I2 = 28%), cardiovascular death (RR 0.94, 95% CI 0.76 to 1.15, p = 0.54, I2 = 0%), myocardial infarction (RR 1.06, 95% CI 0.71 to 1.57, p = 0.79, I2 = 61%), aortic valve reintervention, endocarditis, and bioprosthetic valve failure. New-onset atrial fibrillation was more common in the SAVR group, whereas permanent pacemaker implantation was more common in the TAVR group. In conclusion, our meta-analysis showed that TAVR is associated with similar long-term outcomes compared with SAVR in selected low-risk patients.

Clinical Characterization of Pathogens, Risk Factors and Quality of Life in an Observational Study of Native vs. Prosthetic Aortic Valve Endocarditis Surgery.

Background: Native (NVE) and prosthetic (PVE) aortic valve endocarditis (AVE) remain a surgical challenge with an ongoing trend towards more complex surgical procedures. Methods: First-time NVE was compared with PVE, focusing on pathogens, risk factors, perioperative course, postoperative follow-up, including recurrent infection, as well as health-related quality of life (HRQOL). Results: From 2007 to 2022, surgical intervention for AVE was necessary in 231 patients with 233 episodes of infective aortic valve endocarditis, i.e., there were only two cases of reinfection (NVE group). The study group consisted of 130 cases with NVE and 103 with PVE. Overall, a median of 40.3% of survivors were in NYHA class I or II. In-hospital mortality was higher in the PVE group with 13.3%. The most common pathogen was Staphylococcus aureus, with 24.9% across both groups. EuroSCORE II was higher in the PVE group (19.0 ± 14.3% total, NVE 11.1 ± 8.1%, PVE 27.8 ± 14.6%; p < 0.05), reflecting an older, more co-morbid patient cohort. Abscess formation was also more common in the PVE group, while vegetations were more common in the NVE group. The 5-year and 10-year survival rates did not differ significantly between NVE and PVE and were 74.4% and 52.2% for the NVE group, respectively, and 67.4% and 52.9% for the PVE group, respectively. The HRQOL as assessed by the Minnesota Living with HF Questionnaire (MLHFQ) demonstrated no significant difference between both groups. Conclusions: Long-term survival and QoL after surgical treatment of infective aortic valve endocarditis are excellent and do not depend on the type of replacement.

Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era.

Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan-Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1-1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7-168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L (p = 0.04) and aortic cross-clamp time ≥ 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.

Intraoperative Polymerase Chain Reaction from Cardiac Valve Tissue Is Beneficial for Guiding Further Therapy in Patients with Infective Endocarditis.

Background: Infectious endocarditis (IE) remains a critical condition despite all the medical advances in recent decades. Reliable pathogen identification is indispensable for precise therapy. The aim of this study was to evaluate the diagnostic and therapeutic benefit of additional polymerase chain reaction (PCR) in comparison with microbiological culture alone based on intraoperative tissue sampling for patients operated on due to IE. Methods: A total of 224 patients diagnosed with acute or subacute IE were analyzed. Intraoperatively resected infectious tissue was analyzed using both PCR and microbiological culture. Subsequently, the results of the detection of bacteria obtained based on intraoperative measurements from tissue via culture and PCR were compared with preoperative blood culture results. Furthermore, we evaluated the therapeutic impact of the culture and/or PCR results obtained from cardiac tissue. Results: The 224 patients were 63 ± 17 years old, and 64 (29%) were female. In total, 149 (67%) suffered from aortic valve endocarditis, 45 (45%) had mitral valve endocarditis, and 39 (18%) were afflicted with double-valve endocarditis. Prosthetic valve endocarditis was present in 70 (31%) patients. Pathogens were detected in 70% of the cases analyzed via PCR using cardiac valve tissue and in 25% of those analyzed via a culture of cardiac valve tissue; this figure was only 64% for preoperative blood culture. Overall, a pathogen was identified in 197 patients (88%), leading to antibiotic therapy. Targeted antibiotic therapy, based on the PCR results, was carried out in 37 cases and was conducted based on a culture from cardiac valve tissue in three cases. Finally, in 12% of patients, the causative pathogen remained unclear. Conclusions: For patients suffering endocarditis, PCR analysis is indispensable and superior to preoperative blood culture and intraoperative culture in detecting bacteria. Based on PCR testing, antibiotic therapy can be individually adjusted. The high precision of pathogen identification may lead to a significant reduction in IE-associated morbidity and mortality.

Precise reconstruction of the aortic valve using glutaraldehyde-treated autologous pericardium in new formula: a case report

BackgroundThe current study presents a novel and precise surgical technique for complete reconstruction of the aortic valve using glutaraldehyde-treated autologous pericardium in a patient with aortic valve disease and endocarditis. The technique aims to provide a more effective and reproducible method for aortic valve repair, with the goal of improving outcomes and quality of life for patients with aortic valve disease.Case presentationA 35-year-old Iranian male with aortic valve disease and endocarditis underwent aortic valve reconstruction surgery. Preoperative echocardiography showed a degenerative aortic valve with severe regurgitation, reduced left ventricular ejection fraction, and specific aortic root dimensions. The surgical technique involved precise measurements and calculations to design the size and shape of the new aortic valve cusps using autologous pericardium, with the goal of optimizing coaptation and function. The surgeon calculated the intercommissural distance based on the aortic annulus diameter to determine cusp size and shape. He tailored the pericardial cusps to have a height equal to 80% of the coaptation margin length. Detailed suturing techniques were used to ensure proper alignment and coaptation of the new cusps. Intraoperative evaluation of the valve function using suction and transesophageal echocardiography showed good coaptation and minimal residual regurgitation. At the 3-year follow-up, the patient had a well-functioning aortic valve with only trivial leak and was in satisfactory clinical condition.ConclusionsGlutaraldehyde-treated autologous pericardium is a validated leaflet alternative, and the causes of its failure are late annular dilatation and other technique breakdowns. Current evidence reveals that aortic valve reconstruction with glutaraldehyde-treated autologous pericardium is associated with many advantages with the potential to improve patient outcomes and quality of life. Further clinical studies are warranted to evaluate the long-term durability and efficacy of this approach.

Clinical characteristics and outcomes of aortic prosthetic valve endocarditis: comparison between transcatheter and surgical bioprostheses

Abstract Purpose Most data regarding infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) comes from TAVI registries, rather than IE dedicated cohorts. The objective of our study was to compare the clinical and microbiological profile, imaging features and outcomes of patients with IE after SAVR with a biological prosthetic valve (IE-SAVR) and IE after TAVI (IE-TAVI) from 6 centres with an Endocarditis Team (ET) and broad experience in IE. Methods Retrospective analysis of prospectively collected data. From the time of first TAVI implantation in each centre to March 2021, all consecutive patients admitted for IE-SAVR or IE-TAVI were prospectively enrolled. Follow-up was monitored during admission and at 12 months after discharge. Results 169 patients with IE-SAVR and 41 with IE-TAVI were analysed. Early episodes were more frequent among IE-TAVI. Clinical course during hospitalization was similar in both groups, except for a higher incidence of atrioventricular block in IE-SAVR. The most frequently causative microorganisms were S. epidermidis, Enterococcus spp. and S. aureus in both groups. Periannular complications were more frequent in IE-SAVR. Cardiac surgery was performed in 53.6% of IE-SAVR and 7.3% of IE-TAVI (p=0.001), despite up to 54.8% of IE-TAVI patients had an indication. No differences were observed about death during hospitalization (32.7% vs 35.0%), and at 1-year follow-up (41.8% vs 37.5%), regardless of whether the patient underwent surgery or not. Conclusion Patients with IE-TAVI had a higher incidence of early prosthetic valve IE. Compared to IE-SAVR, IE-TAVI patients underwent cardiac surgery much less frequently, despite having surgical indications. However, in-hospital and 1-year mortality rate was similar between both groups.

From pneumonia to two cardiac surgeries: Aortic valve endocarditis complicated by an aortic root abscess, atrioventricular block, and postoperative left ventricular pseudoaneurysm.

From pneumonia to two cardiac surgeries: Aortic valve endocarditis complicated by an aortic root abscess, atrioventricular block, and postoperative left ventricular pseudoaneurysm.

Fistula of the mitral-aortic intervalvular fibrosa in a patient with bacterial endocarditis: a case report and systematic literature review

SummaryBackgroundA fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention.Case presentationA 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4.ConclusionsThe clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient’s condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.

Aortic valve replacement with rapid-deployment bioprosthesis in case of infective endocarditis: a literature review.

Recently, the use of rapid deployment (RD) aortic valve prostheses has been introduced for the treatment of aortic valve replacement (AVR), showing excellent hemodynamic performances.According to these data, some groups have proposed new RD valves as an alternative solution in the case of infective aortic endocarditis (IAE) to reduce the use of foreign materials, and the manipulation of the annulus.The aim of this review is to report the results of early clinical experiences with the use of RD bioprostheses in the case of IAE, in order to discuss technical and clinical aspects of this emerging strategy to better elucidate its advantages and limitations as a potential therapeutic solution. An in-depth search of PubMed from January to March 2023 was performed. English-language articles were selected independently by authors following the criteria in order to consider all available experiences (full papers, case reports, and case series) that have investigated the use of RD in case of IAE. The use of rapid deployment bioprosthesis represents a bailout strategy in case of severe aortic valve endocarditis and should be evaluated with caution in selected cases. This review collects the first, initial, and pioneering experiences of the use of the RD prosthesis in case of infective endocarditis, particularly when the fragility of the annular tissues precludes a secure anchoring of sutured prostheses.The reduced use of foreign materials by minimizing the number of stitches, the reduced cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the excellent hemodynamic performances associated with the use of RD bioprosthesis represent the most important advantages that could justify their use in the setting of aortic valve endocarditis. Although there are few anecdotal experiences, surgical aortic valve replacement with the use of RD represents an emerging strategy in case of aortic valve endocarditis. Its advantages, pros, and cons are under debate, and robust clinical trials are needed to demonstrate its safety and efficacy.

Heparin-induced DRESS syndrome in a paediatric patient and successful anaesthetic management in cardiovascular bypass surgery: case report

BackgroundDrug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe adverse drug reaction marked by delayed hypersensitivity reactions causing skin and systemic complications. DRESS diagnosis is challenging due to the variety of clinical presentations and symptom overlap with other conditions. The perioperative period in these patients requires precise pharmacological strategies to prevent complications associated with this syndrome. The treatment of DRESS induced by unfractionated heparin during cardiopulmonary bypass (CPB) surgery presents some challenges that must be considered when selecting an anticoagulant to avoid side effects. In this case, bivalirudin, a direct thrombin inhibitor, is indicated as an alternative to heparin in patients undergoing CPB. However, in contrast to heparin/protamine, there is no direct reversal agent for bivalirudin.Case presentationWe report the case of an 11-year-old male diagnosed with native aortic valve endocarditis and thrombosis in his left lower extremity. During valvular replacement surgery, systemic unfractionated heparin was administered. Postoperatively, the patient developed fever, eosinophilia and pruritic rash. Warm shock and elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels followed, leading to the diagnosis of DRESS syndrome. Treatment with methylprednisolone resulted in complete resolution of symptoms. Seven years later, the patient was readmitted due to insufficient anticoagulation and a thrombus in the prosthetic aortic valve, presenting a recurrent DRESS episode due to the administration of unfractionated heparin, which was later replaced with low-molecular-weight heparin during hospitalization. Treatment with corticosteroids and antihistamines was initiated, resulting in the resolution of this episode. Ultimately, the patient required the Ross procedure. During this intervention the anticoagulation strategy was modified, unfractionated heparin was replaced with bivalirudin during the procedure and fondaparinux was administered during the postoperative period. This resulted in stable transaminases levels and no eosinophilia.ConclusionThe severity of DRESS Syndrome underscores the importance of early recognition, heightened monitoring, and a comprehensive approach tailored to each patient’s needs. This particular case highlights the significance of this approach and may have a substantial clinical impact since it provides alternatives to heparin, such as bivalirudin and fondaparinux, in the anticoagulation strategy of CPB for patients who have a hypersensibility reaction to this medication; thus, enhancing clinical outcomes by minimizing risks linked to adverse drug reactions.

Repair of a fistula between the aorta and right ventricular outflow tract secondary to infective endocarditis of a unicuspid aortic valve and previously repaired ventricular septal defect

BackgroundInfective endocarditis of the aortic valve can result in a wide range of destructive pathology beyond the valve leaflets and annulus which require careful surgical planning to provide appropriate debridement and reconstruction. Failure to do so can result in a failure of surgical treatment, recurrent infection and cardiac failure with concomitant high morbidity and mortality.Case reportWe describe the case of a 45-year-old male with previous patch repair of a ventricular septal defect, who was diagnosed with sub-acute bacterial endocarditis of the native aortic valve and developed a new fistula from the aorta to the right ventricular outflow tract which. This was managed surgically.ConclusionThis unique case highlights another spectrum of infective endocarditis with a unique approach to repair and management.

Partial heart transplantation for destructive infective endocarditis

Infective endocarditis frequently spreads beyond the valve tissue, especially in the aortic location. Invasive endocarditis may lead to abscess formation or fistula, with substantial tissue loss. Here, the case of a 31-year-old male patient with destructive aortic and pulmonary valve endocarditis and a subaortic mural defect who underwent patch closure of the ventricular septal defect and aortic and pulmonary root replacement and right coronary artery bypass graft is presented. This is an uncommon condition and stress is placed on imaging of the technical aspects of the case.

Treatment of Late Infective Prosthetic Endocarditis Complicated by Cerebral Infarction with Vegetations: Pharmacotherapeutic Approach (Case Report)

Prosthetic endocarditis is a serious complication in a long term. Vegetation as a thromboembolic complication leads to neurologic deficit varying in severity.&#x0D; Case description. A 35-year-old female patient F. underwent surgical treatment at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery on September 07, 2016: aortic valve replacement with wrapping tape operation II. The patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition. On November 20, 2019, the patient was admitted to the Institute with the diagnosis of late infective prosthetic aortic valve endocarditis, status post aortic valve replacement and wrapping tape operation in 2016, first-degree atrioventricular block, cerebral infarctions in multiple locations with hemorrhagic transformation, with aphasia elements, ataxia, right-sided pyramidal insufficiency and suspected meningitis. After 21 days of drug therapy, the patient responded to treatment successfully and was discharged from the hospital in a satisfactory condition without surgical treatment.&#x0D; Conclusions. Taking into consideration the serious condition of the patient, timely and carefully selected drug therapy can be the correct solution for the treatment of patients with late infective endocarditis. Thus, surgery is not always the treatment of choice.

Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis.

Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality. A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses. Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; p < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; p < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; p < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; p = 0.033). In the nonsurvivor group Staphylococcus aureus was prevalent. Streptococcus viridans was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; p = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality. This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.