Original article
Adult cardiac
Emergency Surgery for Native Mitral Valve Endocarditis: The Impact of Septic and Cardiogenic Shock

https://doi.org/10.1016/j.athoracsur.2011.11.025Get rights and content

Background

Limited information exists about the real impact of the etiology of shock on early and late outcome after emergency surgery in acute native mitral valve endocarditis (ANMVE). This multicenter study analyzed the impact of the etiology of shock on early and late outcome in patients with ANMVE.

Methods

Data were collected in eight institutions. Three hundred-seventy-nine ANMVE patients undergoing surgery on an emergency basis between May 1991 and December 2009 were eligible for the study. According to current criteria used for the differential diagnosis of shock, patients were retrospectively assigned to one of three groups: group 1, no shock (n = 154), group 2, cardiogenic shock (CS [n = 118]), and group 3, septic shock (SS [n = 107]). Median follow-up was 69.8 months.

Results

Early mortality was significantly higher in patients with SS (p < 0.001). At multivariable logistic regression analysis, compared with patients with CS, patients with SS had more than 3.8 times higher risk of death. That rose to more than 4 times versus patients without shock. In addition, patients with SS had 4.2 times and 4.3 times higher risk of complications compared with patients with CS and without shock, respectively. Sepsis was also an independent predictor of prolonged artificial ventilation (p = 0.04) and stroke (p = 0.003) whereas CS was associated with a higher postoperative occurrence of low output syndrome and myocardial infarction (p < 0.001). No difference was detected between groups in 18-year survival, freedom from endocarditis, and freedom from reoperation.

Conclusions

Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies.

Section snippets

Patient Selection

The Ethics Committee of each participating institution approved the study and waved the need for patient consent according to the national law regulating observational retrospective studies (Law nr.11960, released on 13/7/2004).

Data of patients with ANMVE who had undergone emergency surgery between May 1991 and December 2009 were stored in a common database and were sent to a core laboratory (Careggi Hospital, Florence, Italy) for analysis. Indications for emergency surgery, defined as surgery

Early Outcome

Eighty-two patients (21.6%) died either during their hospital stay or within 30 days of operation. The causes of death were sepsis (35.4%), respiratory failure (19.5%), multiorgan failure (15.8%), myocardial infarction (13.4%), massive bleeding (10.9%), and other causes (5%). Early mortality did not change over time (1991 to 1993, 23.5%; 1994 to 1996, 24.0%; 1997 to 1999, 23.0%; 2000 to 2002, 23.0%; 2003 to 2005, 22.0%; 2006 to 2009, 22.2%; p = 0.9).

Early (30-day) death was higher in mitral

Comment

We evaluated long-term postoperative results of emergency surgery for AMVE in patients with shock (either cardiogenic or septic) from a multicenter experience to determine whether a specific etiology of the shock translated into worse postoperative outcome.

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