Periannular Complications in Infective Endocarditis Involving Prosthetic Aortic Valves - 20/08/11
, Jose Alberto San Roman, MD, PhD c, Aristides de Alarcon, MD, PhD d, Manuel Anguita, MD e, Benito Almirante, MD, PhD f, Artur Evangelista, MD f, Christopher H. Cabell, MD, MHS g, Isidre Vilacosta, MD, PhD h, Tomas Ripoll, MD i, Patricia Muñoz, MD, PhD j, Enrique Navas, MD k, Carlos Gonzalez-Juanatey, MD l, Cristina Sarria, MD, PhD m, Ignacio Garcia-Bolao, MD, PhD n, M. Carmen Fariñas, MD o, Gabriel Rufi, MD p, Francisco Miralles, MD q, Carles Pare, MD b, Vance G. Fowler, MD, MHS g, Carlos A. Mestres, MD, PhD b, Elisa de Lazzari, BSC b, Joan R. Guma, MD a, Ana del Río, MD, PhD b, G. Ralph Corey, MD, PhD gAorto-Cavitary Fistula in Endocarditis Working Group †
Corresponding author: Tel: 34-93-227-55-86; fax: 34-93-451-44-38Résumé |
The periannular extension of infection in prosthetic valve endocarditis (PVE) is a serious complication of infective endocarditis associated with high mortality. Periannular lesions in PVE occasionally rupture into adjacent cardiac chambers, leading to aortocavitary fistulae and intracardiac shunting. It is unknown whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinctive clinical characteristics of patients with PVE and either aortocavitary fistulization or nonruptured abscesses. In a retrospective multicenter study of >872 PVE episodes, 150 patients (17%) with periannular complications in PVE in the aortic position were identified (29 with aortocavitary fistulization and 121 with nonruptured abscesses). Early-onset PVE was present in 73 patients (49%). Rates of heart failure (p = 0.09), ventricular septal defect (p <0.01), and third-degree atrioventricular block (p = 0.07) were higher in patients with fistulization. Surgical treatment was undertaken in 128 patients (83%). In-hospital mortality in the overall population was 39%. Multivariate analysis identified heart failure (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6 to 6.8), renal failure (OR 2.5, 95% CI 1.2 to 5.2), and co-morbidity (OR 2.4, 95% CI 1.1 to 5.1) as independent risk factors for death. Fistulous tract formation was not associated with increased in-hospital mortality (OR 1.6, 95% CI 0.7 to 3.7). The actuarial 5-year survival rate in surgical survivors was 100% in patients with fistulae and 78% in patients with nonruptured abscesses (log-rank p = 0.14). In conclusion, aortocavitary fistulous tract formation in PVE complicated with periannular complications is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscesses. Despite the frequent complications, fistulous tract formation in the current era of infective endocarditis is not an independent risk factor for mortality.
Le texte complet de cet article est disponible en PDF.Plan
| This work was supported in part by Grant V-2003-REDC14A-O from “Red Española de Investigación en Patología Infecciosa,” and Dr. Miro was a recipient of a research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. In addition, Dr. Cabell was supported by Grant HL70861 from the National Institutes of Health, Bethesda, Maryland. |
Vol 98 - N° 9
P. 1261-1268 - novembre 2006 Retour au numéro
Article précédent
- Periannular Complications in Infective Endocarditis Involving Native Aortic Valves
- Ignasi Anguera, Jose M. Miro, Artur Evangelista, Christopher H. Cabell, Jose Alberto San Roman, Isidre Vilacosta, Benito Almirante, Tomas Ripoll, M. Carmen Fariñas, Manuel Anguita, Enrique Navas, Carlos Gonzalez-Juanatey, Ignacio Garcia-Bolao, Patricia Muñoz, Aristides de Alarcon, Cristina Sarria, Gabriel Rufi, Francisco Miralles, Carles Pare, Vance G. Fowler, Carlos A. Mestres, Elisa de Lazzari, Joan R. Guma, Asunción Moreno, G. Ralph Corey, Aorto-Cavitary Fistula in Endocarditis Working Group †
- Prevalence of Systolic Impairment in an Unselected Regional Population With Hypertrophic Cardiomyopathy
- Georgios K. Efthimiadis, Georgios Giannakoulas, Despina G. Parharidou, Haralampos I. Karvounis, Soterios T. Mochlas, Ioannis H. Styliadis, Stavros Gavrielides, Konstantinos D. Gemitzis, Georgios D. Giannoglou, Georgios E. Parharidis, Georgios E. Louridas
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?