Early Prosthetic Valve Research Articles

Successful nonsurgical therapeutic management in a case of early mechanical aortic prosthetic thrombosis and coronary embolism after a modified Bentall procedure.

Prosthetic valve thrombosis, although rare, is a life-threatening complication of valve replacement surgery. The authors present an atypical case of a modified Bentall procedure with the CarboSeal Valsalva™ conduit complicated by an early mechanical prosthetic aortic valve thrombosis and coronary embolism. The patient was successfully treated with an emergency percutaneous coronary angioplasty and intracoronary thrombus aspiration of the left anterior descending artery, followed by a systemic 10mg bolus of tissue plasminogen activator followed by ultraslow (25 h) infusion of low-dose (25mg), while supported with venoarterial extracorporeal membrane oxygenation.

Beyond the Timeline: One-year Mortality Trends in Early vs. Late Prosthetic Valve Endocarditis.

Among 302 episodes with prosthetic valve endocarditis (PVE), one-year mortality was 31%. There was no evidence indicating that early-onset PVE within 6 months from valve surgery led to a worse outcome compared to late-onset PVE (21% versus 32%; p=0.126), despite similar redo valve surgeries across both categories.

An Unusual Complication of Early Prosthetic Valve Endocarditis

An Unusual Complication of Early Prosthetic Valve Endocarditis

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.

Microbiological findings in infective endocarditis, event predictor and prognostic value

Abstract Funding Acknowledgements None. Introduction In infective endocarditis, microbial isolation can be related to the prognosis of the disease. Identify the cause of endocarditis can help decide further management appropriate. Our purpose was to evaluate the most frequent microbiological findings in our healthcare area, as well as their association with prognostic determinants. Material and Methods Retrospective, observational, single-center study*. Based on a registry of patients diagnosed with infective endocarditis during the years 2016-2022 in a reference hospital with cardiac surgery. Patients with infective endocarditis were analyzed according to their type of microbial isolation, observing the microbial epidemiology and comparing these groups according to their baseline characteristics (age, sex, risk factors), the different therapeutic management in each group (type of antibiotic treatment used, surgical intervention, surgical indication etc.) and compared the groups according to the frequency of different prognostic determinants and events (Reinfection, Embolism, Shock, Mortality, local complications, etc.). To analyze the differences in events between different groups of microorganisms, the Chi square statistic of Homogeneity was used, and a significance level of p<0.05 was established. Results 162 patients were analyzed for an average of 66 years. The rate of positive blood cultures was 93%. The most frequently isolated microorganisms were, Figure 1. Patients who suffered from S. aureus endocarditis (with a mean age also of 66±10 years) had a higher prevalence of pacemaker infections and were complicated by septic shock more frequently (43%, p<0.01) than patients with other types of microorganism isolation. However, we did not have high surgery rates, and we did not observe significant differences in terms of recurrence or mortality, despite being a very virulent microorganism. On the other hand, S.Epidermidis (which is associated with early prosthetic valve endocarditis) is the microorganism most closely related with abscesses, fistulas or other perivalvular involvements (34%, p=0.04), in relation to endocarditis after valve surgery. This group also appears to have a greater tendency, although not significant, to cause AV blocks. Furthermore, S.Epidermidis was the group of patients that most frequently underwent surgery (62% p<0.001) Figure 2. Conclusions In this study, we have observed a higher frequency of isolation of E. feacalis, with significant differences in comparison to other series, and a significantly higher number of recurrences in comparison to other microorganisms. S. aureus is the microorganism most linked to shock, but it is also the one with the lowest number of undergone surgeries, despite being comparable populations. In valve prosthetic endocarditis, S. epidermidis was the most frequent pathogen isolated, and was more frequently associated with perivalvular involvement and the need for surgery.

A Bayesian network-based approach for identifying risk factors and predicting ischemic stroke in infective endocarditis patients.

This study aimed to seek the risk factors and develop a predictive model for ischemic stroke (IS) in patients with infective endocarditis (IE) utilizing a Bayesian network (BN) approach. Data were obtained from the electronic medical records of all adult patients at three hospitals between 1 January 2018, and 31 December 2022. Two predictive models, logistic regression and BN, were used. Patients were randomly assigned to the training and test sets in a 7:3 ratio. We established a BN model with the training dataset and validated it with the testing dataset. The Bayesian network model was built by using the Tabu search algorithm. The areas under the receiver operating characteristic curve (AUCs), calibration curve, and decision curve were used to evaluate the prediction performance between the BN and logistic models. A total of 542 patients [mean (SD) age, 49.6 (15.3) years; 137 (25.3%) female] were enrolled, including 151 (27.9%) with IS and 391 (72.1%) without IS. Hyperlipidemia, hypertension, age, vegetation size (>10 mm), S. aureus infection, and early prosthetic valve IE were closely correlated with IS. The BN models outperformed the logistic regression in training and testing sets, with accuracies of 76.06% and 74.1%, AUC of 0.744 and 0.703, sensitivities of 25.93% and 20.93%, and specificities of 96.27% and 90.24%, respectively. The BN model is more efficient than the logistic regression model. Therefore, BN models may be suitable for the early diagnosis and prevention of IS in IE patients.

Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report

Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report

An Early Prosthetic Valve Endocarditis in Presence of COVID-19-Associated Pneumonia

Introduction. Coronavirus disease (COVID-19)-associated pneumonia was a dangerous disease at the beginning of 2021. However, there are almost no records of early infectious endocarditis of prosthetic heart valve in the presence of such a disease. We present an interesting clinical case of successful treatment of complicated pathology.
 The COVID-19 outbreak involved unique clinical complications that were superimposed on the progressive heart failure due to prosthetic mitral valve dysfunction (its detachment) which did not allow time for active antiinflammatory therapy. Urgent replacement of the prosthesis made it possible to eliminate the infection and paved the way for successful long-term antibacterial, antifungal and antiviral therapy.
 The aim. To determine the features of management of patients with complex clinical pathology: prosthetic valve endocarditis associated with COVID-19 and severe lung inflammation in the early postoperative period.
 Case report. This work presents rare clinical case. A 46-year old male patient underwent successful surgery (mitral valve replacement with posterior leaflet preservation and left atrium resection) at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery and was discharged in satisfactory condition. One month later, he was hospitalized again and diagnosed with an early infectious endocarditis of prosthetic mitral valve and bilateral polysegmental COVID-19-associated pneumonia. After a week of medicinal preparation (antibacterial therapy), the patient underwent repeat mitral valve replacement in the presence of progressive heart insufficiency due to increasing paravalvular insufficiency. Postoperative period elapsed without significant complications. The patient was discharged in satisfactory condition on day 15 after surgery and primary rehabilitation.
 Conclusion. Having a specific etiology, pneumonia significantly damaged mitral prosthesis structures by increasing paravalvular insufficiency. Consequently, the patient underwent life-saving repeat mitral valve replacement in the presence of COVID-19-associated pneumonia and under massive antibacterial treatment which continued for 60 days after the patient’s discharge. An important element of successful treatment of COVID-19-associated pneumonia is the selection of adequate antibacterial, antifungal and antiviral drugs.

A relapsed Pseudomonas stutzeri prosthetic valve endocarditis: a\xa0case report and review of the\xa0literature

BackgroundPseudomonas stutzeri is a nonfluorescent denitrifying bacterium widely distributed in the environment, and it has also been isolated as an opportunistic pathogen from humans. It is a Gram-negative bacterium and a common inhabitant of soil and water.Case presentationWe report the case of a 51-year-old arab gentleman who has systemic lupus erythematous complicated by lupus nephritis and underwent renal transplantation twice. He underwent mitral valve replacement and 4 years later was diagnosed with prosthetic valve endocarditis caused by Pseudomonas stutzeri.ConclusionsLiterature review was conducted and revealed that this pathogen may be of a particular medical relevance in immunocompromised patients. Our case proves that early infection and relapse despite optimal antibiotics course are possible outcomes of Pseudomonas stutzeri endocarditis. To the best of our knowledge, this is the second case of fulminant early prosthetic valve endocarditis occurring only 1 month post-cardiac surgery with relapse despite a complete antibiotics course.

Hemodynamically significant prosthesis-patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis.

To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction. Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption. 205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR=2.56; 95%CI 1.30-5.05; P=.006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P<.001), compared to those without PPM. The association between PPM and prosthetic valve dysfunction was maintained after adjusting for gender, age, and ever-smoking (OR=9.03; P<.001). The incidence of thrombosis or pannus was also nonsignificantly higher in patients with moderate or severe PPM. Predicted PPM identifies the presence, possibly not the severity, of actual postoperative PPM. Moderate or severe PPM is associated with prosthetic valve dysfunction. Actual postoperative prosthesis-patient mismatch measured within 60 postoperative days showed a distinctive hemodynamic profile and presented a stronger association with prosthetic valve dysfunction than predicted prosthesis-patient mismatch. A. Echocardiographic follow-up in patients according to the actual postoperative PPM measured within 60 postoperative days. B. Prediction of prosthetic valve dysfunction based on preoperative predicted PPM or on actual postoperative PPM within 60 postoperative days. PPM: prosthesis-patient mismatch. OR: Odds ratio.

Surgicel mimicking early onset prosthetic valve endocarditis: case report.

BackgroundSurgicel is one of the commercial forms of oxidized regenerated cellulose used as a bioabsorbable topical haemostatic agent during surgical procedures. However, its presence can mimic an abscess, tumour, lymph node or retained foreign body on imaging studies. The challenge in cardiac surgery is to differentiate the haemostatic material from an abscess that might be mistaken for an early onset prosthetic valve endocarditis.Case summaryA 56-year-old woman was admitted to our department for a suspicion of early onset prosthetic valve endocarditis after an aortic valve replacement. An early clinical and biological improvement, features on a chest computed tomography scan, as well as a surgical correlation were able to rectify the diagnosis. The acute fever was linked to urinary tract infection, whereas the periaortic echogenic mass shown at the transoesophageal echocardiography corresponded to Surgicel.DiscussionOxidized regenerated cellulose can mimic an abscess on cardiac imaging, especially when used in excess during cardiac surgery. Fortunately, some radiographic features can help differentiate the haemostatic material from an abscess. Hence, sharing the use and location of Surgicel between the surgeon, radiologist, and cardiologist is very important and necessary to make the correct diagnosis.

Bicuspid aortic valve repair using geometric ring annuloplasty: A first-in-humans pilot trial.

ObjectiveAs bicuspid aortic valve (BAV) repair evolves, more effective annular reduction and stabilization could be advantageous. A geometric annuloplasty ring has been developed, and 2-year regulatory outcomes of a first-in-humans pilot trial are reported.MethodsA prospective first-in-humans trial of BAV ring annuloplasty was completed in 16 patients. Patient age was 44.4 ± 11.3 (mean ± standard deviation) years, preoperative aortic insufficiency grade was 2.5 ± 1.0, New York Heart Association class 1.8 ± 0.4, and mean systolic gradient 13.4 ± 12.9 mm Hg. Three patients had Sievers type 0 BAV, 11 had type 1, and 2 were type 2. The Dacron-covered titanium rings had circular base geometry with 180° subcommissural posts and were implanted subannularly. Leaflets were reconstructed using plication/cleft closure, creating an effective height of ≥8 mm, even if modest gradients were induced.ResultsMean pre-repair annular diameter was 28.6 ± 3.3 mm, and the average ring diameter was 22.3 ± 1.6 mm. All valves required leaflet plication/reconstruction; pericardium was avoided; and 7 patients had aortic replacement for aneurysms. No early mortalities or major complications occurred. Two patients required early prosthetic valve replacement for technical errors, and all were between 24-38 months’ postoperative at follow-up. No late mortalities or valve-related complications occurred, and all patients reverted to New York Heart Association class I. Aortic insufficiency reduction was significant to grade 0.9 ± 0.5 at 2-years (P < .0001). Mean valve gradients were acceptable (13.3 ± 5.0 mm Hg at 2 years; overall P = .11) and tended to fall over time (P < .0001).ConclusionsGeometric ring annuloplasty was safe and effective for BAV repair. AI reduction was significant, valve gradients were satisfactory, and clinical outcomes were excellent. Geometric ring annuloplasty could simplify and standardize BAV repair.

Valve-related factors and incidence of prosthetic valve endocarditis.

AimThe aim of the study was to present our experience and evaluate the valve-related factors and the incidence of prosthetic valve endocarditis.Material and methodsThis is a retrospective study. Between 2010 and 2018, 36 patients were re-operated on due to prosthetic valve endocarditis The valve-related factors (type, size and position of the prosthetic valve) were analysed.ResultsThirty-six patients had prosthetic valve endocarditis. The overall hospital mortality was 16.67%. Early vs. late onset prosthetic valve endocarditis mortality was 23.08% vs. 13.04% respectively. The type, size or position of the prosthesis was not associated with prosthetic valve endocarditis. There was a statistically significant difference between occurrence of prosthetic infection between mitral repair and replacement both in mechanical and biological valve groups. The most common infective agent in the early onset group was Staphylococcus aureus, whereas in the late onset group it was Enterococcus faecalis. Out of 13 patients with early prosthetic valve endocarditis, 11 had infection in the perioperative period around primary operation.ConclusionsBased on our experience, prosthetic valve endocarditis has a high mortality. Early onset prosthetic valve endocarditis is less common but has higher mortality compared to the late onset. Mitral valve repair was less prone to develop prosthetic valve endocarditis, and valve-related factors (type and size of the valve, valve position) did not have any influence on the incidence of prosthetic valve endocarditis.

Acute arterial embolism of lower extremity after mitral valve replacement in a chronic lymphocytic leukaemia patient: a case report

Introduction Acute arterial embolism is a potential severe complication after cardiac surgery: it can be a clinical manifestation of early prosthetic valve (PV) thrombosis, whose incidence is higher in case of mechanical mitral valve or in presence of subtherapeutic anticoagulation, hemodynamic (atrial fibrillation) or haemostatic (obesity, anaemia, renal failure) predisposing factors (1). EACTA guidelines recommend to start anticoagulation during the first 24 hours after surgery, balancing the haemorragic risk(2). Although, in presence of specific comorbidities and risk factors, life-threatening thrombotic events can complicate postoperative period even following the international recommendations. Methods We report a 73-year-old man, suffering from chronic lymphocytic leukaemia (without treatment) and paroxysmal AF who received mitral mechanical valve replacement with a On-X 27/29 mm valve placed on anti-anatomic position because of a severe mitral insufficiency (with chordal systolic anterior movement) and single coronary artery by-pass graft. Unfractionated heparin (UFH) and acetylsalicylic acid were started 18 hours after surgery, in order to maintain an aPTT ratio of 1.5 to 2.5. On postoperative day (POD) 4 patient presented sudden pain and signs of acute hypoperfusion in left leg (distal femoral artery territory), requiring urgent surgery. Transthoracic echocardiography was performed but limited by artefacts and suboptimal acoustic windows. Considering the high risk surgery and the usefulness of early transoesophageal echocardiography (TOE), the patient received a general anaesthesia with tracheal intubation. Results Successful open embolectomy on the common femoral artery was performed; UFH perfusion was maintained during the whole duration of the procedure without haemorrhagic complication. Intraoperative TEO detected spontaneous echo contrast in left atrial appendage and reduced motion with impaired coaptation of the right leaflet (red arrows in figure); neither valvular-atrial-ventricular thrombus nor increased transvalvular gradient nor regurgitation were found. Postoperative TEO (POD 3) showed a PV with normal leaflets movement, without significative stenosis/regurgitation. Warfarin was started on POD 4 and heparin bridging was discontinued when INR target range was reached. Discussion In patient with multiple thrombotic risk factor (id malignancy, AF) adequate anticoagulation level can be difficult to reach: in these cases, serious thrombotic complications must be highly suspected even when guidelines have been followed. Prompt diagnosis and aggressive treatment are crucial to guarantee a good prognosis. Early TOE and a “tailored” anticoagulation therapy play a fundamental role in the management of such complications.

Early Prosthetic Valve Malfunction Leading to Cardiogenic Shock and Emergency Redo Mitral Valve Replacement

Early onset prosthetic valve stenosis is an uncommon complication after valve replacement surgery and is often caused by thrombus formation. Frequently it can be diagnosed by echocardiography and managed with optimizing anticoagulation and/or thrombolysis. We review a unique case of early bi-leaflet mechanical heart valve (BMHV) dysfunction where the patient rapidly progressed to cardiogenic shock requiring emergent re-do mitral valve surgery. Intraoperatively, the valve leaflets were found to be almost completely immobile secondary to thrombus formation directly on the hinges of the valve. This case demonstrates how the leaflet orientation of a BMHV affects transmitral flow and fluid dynamics. Furthermore, we also discuss left atrial vortex formation in the setting of atrial fibrillation, kinetic energy transfer through an anatomically implanted mechanical mitral valve, and their roles in contributing to early prosthetic valve thrombosis despite adequate anticoagulation.

Predictors of surgical outcome in isolated prosthetic mitral valve endocarditis.

Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve endocarditis included patients with aortic and/or mitral valve prostheses. Here, we concentrate on isolated prosthetic mitral endocarditis due to heterogeneity of epidemiological data, anatomical factors, and surgical techniques between mitral, prosthetic mitral, and aortic endocarditis between prosthetic mitral and prosthetic aortic endocarditis. Methods Data of 40 patients reoperated upon due to isolated prosthetic mitral endocarditis between July 2015 and March 2017 were retrospectively collected and analyzed. Results Independent predictors of major postoperative complications on multivariate analysis were: no blood cultures before referral (odds ratio 6.36, 95% confidence interval: 1.44-28.15), inadequate response to medical treatment (odds ratio 11.38, 95% confidence interval: 1.29-100.25), and serum creatinine ≥2.0 mg·dL-1 (odds ratio 4.56, 95% confidence interval: 1.07-19.36). Independent predictors of hospital mortality were: congestive heart failure (odds ratio 30.91, 95% confidence interval: 2.02 to 473.87), embolization (odds ratio 18.24, 95% confidence interval:1.94-171.91), peri-annular extension of infection (odds ratio 12.68, 95% confidence interval: 1.30-123.43), serum creatinine on admission > 2 mg·dL-1 (odds ratio 9.67, 95% confidence interval: 1.97-47.48), and early prosthetic valve endocarditis (odds ratio 7.80, 95% confidence interval: 1.35-45.00). EuroSCORE II > 5.93% was associated with the highest predictive value for hospital mortality (area under the curve 0.813). Conclusion Certain factors can predict morbidity and mortality in surgery for isolated mitral prosthetic valve endocarditis. EuroSCORE II has a good ability to predict hospital mortality in surgery for mitral prosthetic valve endocarditis.

Experience of treatment of prosthetic valve endocarditis: a retrospective single-center cross-sectional study.

The aim of this study was to describe the experience of treatment of early prosthetic valve endocarditis at a heart center. Retrospective single-center study on data collected from electronic medical records covering the period from January 2009 to December 2015. Over the study period, 1,557 consecutive valve operations were performed on adult patients. The study population comprised 32 patients (2%) who were diagnosed with prosthetic valve endocarditis within 12 months after the index surgery. Medical records were retrieved from electronic hospital records, retrospectively. Descriptive clinical, echocardiographic, microbiological and treatment-type data were used. Risk factors for early mortality were studied through univariate and multivariate analyses. The main clinical manifestation of infective endocarditis was fever, and this was present in all patients. Most of the prostheses were affected in the aortic position (40.6% of cases). The most commonly cultured microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. Twenty-six patients (81.3%) underwent surgical treatment and six (18.7%) underwent exclusive clinical treatment. The prevalence of postoperative complications was 31.3% and hospital mortality occurred in seven cases (21.9%). The mortality rate was 50% among the patients who underwent medical treatment and 15.4% among those who underwent surgery. There were no independent risk factors for mortality. Prosthetic valve endocarditis is an infrequent complication of valve replacement. Surgical treatment has mortality rates compatible with the severity of patients' conditions. Surgical indication should not be delayed when clinical treatment has been ineffective.

Risk factors for early onset prosthetic valve endocarditis: a case–control study

Early onset prosthetic valve endocarditis (EO-PVE) is an infrequent complication of cardiac valve surgery. It is considered a healthcare-associated infection due to contamination of the prosthesis during the implant or in the early postoperative period. To evaluate which factors may be related to the acquisition of EO-PVE. A nested case-control study was conducted from 2006 to 2016. Cases were patients who had definite prosthetic endocarditis by the modified Duke criteria up to 12 months of heart valve replacement. Cases and controls were matched by age, gender, date and type of surgery. There were 26 cases and 78 controls, in 2496 valve surgeries. The median incidence of EO-PVE was 1.1%. Risk factors identified during surgery were: use of ≥2 cryoprecipitate units (odds ratio (OR): 5.95; 95% confidence interval (CI): 1.31-27.0) and ≥2 plasma units (OR: 2.73; 95% CI: 1.0-7.5). In the postoperative period, associated factors were bloodstream infection (OR: 14.00; CI: 1.49-131.77), pneumonia (4.38; 1.21-15.84), any infection (4.46; 1.63-12.21), central line for ≥2 weeks (5.33; 2.06-13.78), presence of dialysis catheter (3.22; 1.15-9.03), and new open chest surgery (3.89; 1.28-11.78). Mortality at 12 months was 34.6% in cases and 6.4% in controls (OR: 7.73; CI: 2.3-26.06). Cases had more infections, invasive procedures and surgical re-interventions in the early postoperative period, which favoured contamination of the newly implanted prosthesis. A preventive approach, with reinforcement of infection control practices, may curb the incidence of this condition.

Subclinical Endocarditis Might be a Hidden Trigger of Early Prosthetic Valve Calcification: A Histological Study.

Despite various improvements in valve prosthetics, early valve deterioration still occurs, leading to prosthetic failure. Studying the early phase of this deterioration is quite difficult, as the prosthesis to be examined is almost always explanted only after extensive deterioration. The objective of this research is to study the pathology of early valve deterioration in an early stage in order to reveal the possible trigger of the process. Three cusps of the same type of bovine pericardium valve prosthesis underwent comparative examination. Two cusps (cusps 1 and 2) were retrieved from a valve prosthesis explanted three months post-implantation, and the third cusp was from a non-implanted valve prosthesis and used as a reference cusp (ref. cusp). The examination included macroscopic examination, Non-linear Optical Microscopy using a multiphoton microscope, and histological examination with staining, using Hematoxylin and Eosin, Movat Pentachrome stain, Von-Kossa stain, and Alizirin-Red stain. Parallel sections were decalcified using Osteosoft® solution prior to Von-Kossa and Alizirin-Red staining to exclude false positive results. Macroscopically, cusp 1 showed early deterioration, and cusp 2 showed endocarditic vegetations. Histologically, cusp 1 showed calcifications in acellular deposits on the surface of the cusp, with pathological signs of subacute/healed endocarditis and intact cusp tissue. The examination did not show calcifications of the cellular remnants within the valve tissue. Cusp 2 showed florid endocarditis, with microscopic destruction of the valve tissue. Early prosthetic valve deterioration can exist as early as three months post-implantation. Subacute or subclinical endocarditis can be the cause for early valve calcification and deterioration.

Early Onset Prosthetic Valve Endocarditis: Experience at a Cardiothoracic Surgical Hospital, 2006-2016.

Early onset prosthetic valve endocarditis (EO-PVE) is an serious complication associated with heart valve replacement surgery. To describe the epidemiologic, clinical, and laboratory profile of patients with EO-PVE in a cardiac surgical hospital. A retrospective analysis of an endocarditis database, implemented prospectively, with a post hoc study driven by analysis of cases of adults with definite endocarditis occurring up to 12 months after heart valve surgery. We identified 26 cases in 2,496 surgeries in the period 2006-2016. The average annual incidence was 1.04%. The median time between valve replacement and the diagnosis of EO-PVE was 33 days (interquartile range [IQR] 19.25-118.75). Biologic and mechanical prostheses were affected in 53.8% and 46.2%, respectively. Rheumatic disease was present in 57.7% of patients. The most common causative pathogens were Staphylococcus epidermidis (23.1%). No Staphylococcus aureus infection was reported. Complications were present in 73.1% of cases, including embolism (65.4%), acute renal failure (38.5%), and heart failure (23.1%). The mortality rate at 30 days and 12 months was 3.8% and 34.6%, respectively. In our cohort EO-PVE was an serious complication of heart valve replacement with a high morbidity and mortality, despite its low frequency.