Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Operative Technique
2.3. Postoperative Care
2.4. Endpoints and Definitions
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Operative Characteristics
3.3. Endpoints
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Limited-Resection n = 45 | Radical-Resection n = 45 | p |
---|---|---|---|
Demographics | |||
Age, years ± SD | 60 ± 14 | 62 ± 13 | 0.446 |
Gender, female, n (%) | 15 (33) | 16 (36) | 0.824 |
Diabetes, n (%) | 10 (22) | 12 (27) | 0.624 |
Drug abuse, n (%) | 3 (7) | 1 (2) | 0.616 |
Previous stroke, n (%) | 18 (40) | 16 (36) | 0.664 |
- Endocarditis related, n | 17 | 15 | 0.660 |
- Neurologic dysfunction, n | 13 | 12 | 0.814 |
CAD, n (%) | 10 (22) | 11 (24) | 0.803 |
Atrial fibrillation, n (%) | 12 (27) | 13 (29) | 0.814 |
Pulmonary disease, n (%) | 6 (13) | 6 (13) | >0.999 |
Dialysis, n (%) | 4 (9) | 7 (16) | 0.334 |
Liver disease, n (%) | 4 (9) | 2 (4) | 0.677 |
PVD, n (%) | 6 (13) | 7 (16) | 0.764 |
Previous CABG, n (%) | 3 (7) | 3 (7) | >0.999 |
Previous PCI, n (%) | 2 (4) | 3 (7) | >0.999 |
Previous valve surgery, n (%) | 3 (7) | 4 (9) | >0.999 |
EuroSCORE II, mean ± SEM | 10 ± 2 | 11 ± 2 | 0.642 |
Clinical status | |||
NYHA fc III-IV, n (%) | 25 (56) | 21 (47) | 0.399 |
Intubated, n (%) | 5 (11) | 4 (9) | 0.725 |
Vasopressor need, n (%) | 5 (11) | 5 (11) | >0.999 |
Surgical delay, days ± SD | 16 ± 2 | 17 ± 3 | 0.940 |
Inflammatory status | |||
CRP, mg/dL (IQR) | 4.90 (1.95–10.25) | 5.00 (1.95–8.55) | 0.692 |
PCT, ng/mL (IQR) | 0.21 (0.08–0.36) | 0.28 (0.14–0.61) | 0.199 |
WBC, 109/L (IQR) | 8.24 (5.56–11.52) | 8.60 (6.56–12.27) | 0.169 |
Echocardiographic parameters | |||
LVEF > 50%, n (%) | 35 (78) | 39 (87) | 0.270 |
Severe MR, n (%) | 24 (53) | 33 (73) | 0.049 |
Concomitant AV IE, n (%) | 8 | 12 | 0.310 |
Concomitant TV IE, n (%) | 3 | 2 | >0.999 |
Variables | Limited-Resection n = 45 | Radical-Resection n = 45 | p |
---|---|---|---|
Causative microorganism | |||
Staphylococcus species, n (%) | 19 (42) | 11 (24) | 0.074 |
- Staphylococcus aureus, n | 13 | 8 | 0.213 |
Streptococcus species, n (%) | 5 (11) | 12 (27) | 0.059 |
Enterococcus species, n (%) | 5 (11) | 6 (13) | 0.748 |
Others, n (%) | 4 (9) | 4 (9) | >0.999 |
Negative, n (%) | 12 (27) | 12 (27) | >0.999 |
Indication for surgery | |||
Heart failure, n (%) | 8 (18) | 16 (36) | 0.057 |
Large or embolized vegetation, n (%) | 28 (62) | 19 (42) | 0.058 |
Uncontrolled infection, n (%) | 8 (18) | 8 (18) | >0.999 |
Valvular disease, n (%) | 1 (2) | 2 (4) | >0.999 |
Timing of surgery | |||
Elective (>7 days), n (%) | 34 (76) | 31 (69) | 0.480 |
Urgent (2–7 days), n (%) | 7 (15) | 8 (18) | 0.777 |
Emergent (<2 days), n (%) | 4 (9) | 6 (13) | 0.502 |
Variables | Limited-Resection n = 45 | Radical-Resection n = 45 | p |
---|---|---|---|
Isolated mitral valve surgery, n (%) | 24 (53) | 16 (36) | 0.090 |
Concomitant CABG, n (%) | 4 (9) | 7 (16) | 0.334 |
Concomitant AV surgery, n (%) | 13 (29) | 15 (33) | 0.649 |
Concomitant TV surgery, n (%) | 5 (11) | 7 (16) | 0.535 |
Minimally invasive, n (%) | 2 (4) | 6 (13) | 0.266 |
CPB time, minutes (IQR) | 92 (73–117) | 128 (111–172) | <0.001 |
ACC time, minutes (IQR) | 59 (45–78) | 84 (73–121) | <0.001 |
Variables | Limited-Resection n = 45 | Radical-Resection n = 45 | p |
---|---|---|---|
Primary | |||
Repair rate, n (%) | 38 (84) | 8 (18) | <0.001 |
Mortality (30-Day), n (%) | 11 (24) | 6 (13) | 0.178 |
- Sepsis-related, n | 6 | 6 | >0.999 |
Secondary | |||
Mortality (2-Year), n (%) | 15 (33) | 12 (26) | 0.490 |
Re-endocarditis, n (%) | 2 (4) | 4 (9) | 0.677 |
Re-operation, n (%) | 3 (7) | - | 0.242 |
Postoperative IABP, n (%) | 2 (4) | 2 (4) | >0.999 |
Postoperative ECMO, n (%) | - | 2 (4) | 0.494 |
Dialysis, n (%) | 9 (20) | 11 (24) | 0.612 |
Reintubation, n (%) | 5 (11) | 13 (29) | 0.035 |
ICU-stay, days (IQR) | 5 (2–10) | 6 (4–11) | 0.129 |
Hospital stay, days (IQR) | 13 (10–21) | 14 (9–20) | 0.771 |
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Haidari, Z.; Wendt, D.; Thielmann, M.; Jakob, H.; Ruhparwar, A.; El-Gabry, M. Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery. J. Cardiovasc. Dev. Dis. 2023, 10, 146. https://doi.org/10.3390/jcdd10040146
Haidari Z, Wendt D, Thielmann M, Jakob H, Ruhparwar A, El-Gabry M. Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery. Journal of Cardiovascular Development and Disease. 2023; 10(4):146. https://doi.org/10.3390/jcdd10040146
Chicago/Turabian StyleHaidari, Zaki, Daniel Wendt, Matthias Thielmann, Heinz Jakob, Arjang Ruhparwar, and Mohamed El-Gabry. 2023. "Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery" Journal of Cardiovascular Development and Disease 10, no. 4: 146. https://doi.org/10.3390/jcdd10040146