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Infective endocarditis in patients with aortic grafts
Daniel García-Arribas1, Carmen Olmos1, Isidre Vilacosta1
1Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), C/ Prof. Martín Lagos, s/n, Madrid 28040, Spain.
International Journal of Cardiology
|February 16, 2021
Summary
Infective endocarditis in patients with aortic grafts has similar mortality to other prosthetic valve endocarditis cases. Diagnosis relies on imaging, and while surgery is common, conservative antibiotic therapy may be suitable for select patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Innovation
Background:
- Infective endocarditis (IE) affecting patients with aortic grafts presents diagnostic and therapeutic challenges.
- This study focuses on the clinical characteristics, diagnosis, and outcomes of IE in patients with valve-tube ascending aortic grafts (AAG).
Purpose of the Study:
- To describe the clinical features, diagnostic methods, and outcomes of infective endocarditis in patients with ascending aortic grafts.
- To compare mortality rates and identify risk factors associated with IE in this specific patient population.
Main Methods:
- Retrospective analysis of 1654 IE episodes from 1996-2019 across three centers.
- Included 37 patients with prosthetic aortic valve and AAG-IE (composite valve graft or supracoronary graft).
- Utilized transesophageal echocardiography (TEE) and PET/CT for diagnosis.
Main Results:
- Staphylococci were the most common pathogens (32%).
- TEE was positive in 89.2% and PET/CT in all cases where performed.
- In-hospital mortality was 16.2%, with heart failure and graft type (supracoronary) as significant risk factors. Mortality was lower for composite valve grafts (4.8%) vs. supracoronary grafts (31.3%).
Conclusions:
- Mortality for IE in AAG patients with prosthetic valves is comparable to other prosthetic IE cases.
- Multimodality imaging is crucial for diagnosis and management.
- Conservative antibiotic management may be a viable alternative to surgery in selected patients.
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