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Clinical course, microbiologic profile, and diagnosis of periannular complications in prosthetic valve endocarditis
J A San Román1, I Vilacosta, C Sarriá
1Hospital Universitario, Valladolid, Spain.
Abstract:
Whether periannular extension of prosthetic valve endocarditis (abscesses, pseudoaneurysms, fistulas) is related to the etiologic agent, the clinical course and the prognosis is still unknown. Likewise, transesophageal echocardiographic accuracy in detecting periannular complications in prosthetic recipients remains unsettled. We retrospectively analyzed data from 87 patients with anatomically proven prosthetic valve endocarditis who underwent a transesophageal echocardiographic examination. Periannular complications (30 abscesses, 18 pseudoaneurysms, 8 fistulas; 8 with >1) were found in 46 patients; results were compared with the remaining 41 without complications. Transesophageal echocardiography correctly identified 27 abscesses (90%) and all pseudoaneurysms and fistulas. One diagnosis of pseudoaneurysm by echocardiography was not found at surgery. No statistical differences were found regarding age, sex, type of prosthesis (mechanical vs biologic), and etiologic agent. Periannular complications were more frequent in aortic location (70% vs 20% in mitral position; p <0.001) and in early (within 6 months after surgery) endocarditis (63% vs 38% in late endocarditis; p = 0.04). The same percentage of patients from both groups underwent surgery (98% with and 90% without complications). At discharge, 62% and 67% of patients were alive, respectively. Thus, periannular complications in prosthetic valve endocarditis are more frequent in aortic location and within 6 months after surgery. Neither the type of prosthesis nor the etiologic agent are related to the presence of periannular complications. Short-term prognosis in patients who underwent surgery is not affected by the presence of periannular complications.
Insights
Periannular complications in prosthetic valve endocarditis are more common in the aortic position and early after surgery. These complications do not affect the short-term prognosis for patients undergoing surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Periannular extension in prosthetic valve endocarditis (PVE) includes abscesses, pseudoaneurysms, and fistulas.
- The relationship between PVE complications, causative agents, clinical course, and prognosis is not well understood.
- Transesophageal echocardiography (TEE) accuracy in detecting PVE periannular complications requires further clarification.
Purpose of the Study:
- To investigate the association between periannular complications in PVE and etiologic agents, clinical presentation, and patient outcomes.
- To evaluate the diagnostic accuracy of TEE in identifying periannular complications in patients with PVE.
- To identify risk factors for the development of periannular complications in PVE.
Main Methods:
- Retrospective analysis of 87 patients with anatomically confirmed PVE who underwent TEE.
- Comparison of patients with and without periannular complications identified via TEE and surgical findings.
- Statistical analysis to assess differences in demographics, prosthesis type, etiologic agents, complication rates, and outcomes.
Main Results:
- Periannular complications were detected in 46 patients (53%) by TEE, with high accuracy for abscesses (90%), pseudoaneurysms, and fistulas.
- Complications were significantly more frequent in aortic (70%) versus mitral (20%) PVE (p < 0.001) and in early (63%) versus late (38%) endocarditis (p = 0.04).
- No significant differences were observed regarding age, sex, prosthesis type, or etiologic agent. Surgical rates (98% vs 90%) and survival at discharge (62% vs 67%) were similar between groups.
Conclusions:
- Periannular complications in PVE are more prevalent in aortic valve prostheses and occur within six months post-surgery.
- Prosthesis type and specific etiologic agents are not associated with the presence of periannular complications.
- The short-term prognosis after surgery for PVE is not adversely affected by the presence of periannular complications.