Determinants and Results of Early Surgery for Prosthetic Valve Endocarditis with Periannular Extension

Infective endocarditis (IE) is a rare but potentially fatal complication of valve replacement, especially if it is accompanied by periannular extension. In these cases surgical intervention is recommended by consensus and clinical guidelines. However, surgery is frequently delayed or not performed, and the best timing for intervention is still controversial. The aim of this study is to analyze determinants of early surgery of patients with prosthetic valve endocarditis (PVE) with periannular extension (PVEPE) and the influence of timing for surgery in morbidity and mortality in a real clinical scenario. Retrospective analysis of a prospective database registry including 180 consecutive patients with definite diagnosis of endocarditis according to modified Duke`s criteria, admitted between 6/2008 and 1/2016, showed 88 patients (49%) with PVE, 48 (54.5%) of them had periannular extension. The patients with PVEPE were divided in 3 groups according to timing for surgery after admission: GA (17p; 10 days) and GC (16p; only medical treatment). We analyzed demographic, clinical, microbiological and echocardiographic variables and we related the treatment strategy selected with in-hospital evolution. Comparing the 3 different groups, we observed that the patients in GA were significantly younger, with a higher frequency of male gender and Staphylococcus spp was significantly the most common microorganism; they had less postoperative complications (64% vs 100%, p: 0.019) and a trend to lower in-hospital mortality (18% vs 46%; p= 0,07). In conclusion, younger male patients with staphylococci PVEPE underwent surgery earlier. This strategy was associated with less anatomical damage and less incidence of postoperative complications with a trend to lower in-hospital mortality.