Abstract 14886: Outcome of Early Surgery in Active Infective Endocarditis in Terms of Intraoperative Valve Culture

Introduction: In recent years, the benefit of early surgery in active infective endocarditis (IE) has been reported. The drawback of early surgery is the risk that residual bacteria in the operative field may cause IE recurrence. Little is known regarding the relationship between intraoperative valve culture and recurrence. In the present study, we investigated the value of early surgery for IE based on the results of valve cultures. Hypothesis: Positive intraoperative valve cultures in early surgery are associated with recurrence. Methods: Between 2009 and 2017, 585 patients underwent valve surgery for definitive left-sided active IE at 14 affiliated hospitals. Early surgery was defined as surgery within 14 days from diagnosis, and patients with unknown valve culture results were excluded. We analyzed the short and mid-term outcome in patients with early surgery (n=228). These 228 patients were compared in two groups: positive (Group P, n=106) and negative (Group N, n=122) valve cultures. The primary outcome was all-cause mortality. Secondary outcomes were recurrence of IE. Mean follow-up time was 2.5±2.8 years. Results: Patients in group P had a significantly higher inflammatory response on preoperative blood tests (White blood cell count: 10.4 (8.3-14.5) vs. 8.2 (6.0-12.7) х10 3 /μl, p=0.005, C-reactive protein: 7.3 (3.8-11.0) vs. 3.8 (2.1-6.8) mg/dl, p<0.001). Patients in group P also had a significantly shorter duration from diagnosis to surgery (2 (1-4) vs. 4 (1-9) days, p<0.001). There was no significant difference in in-hospital mortality between the two groups (13/106 (12%) vs. 11/122 (9%), p=0.43). The overall survival rate at 1 and 5 years was 83% and 69% in group P, 82% and 75% in group N, respectively (p=0.85). The rate of freedom from the recurrence of endocarditis at 1 and 5 years postoperatively was 97% and 82% in group P, and 98% and 92% in group N, respectively (p=0.02). In Cox's hazard analysis, positive valve culture was a risk factor for IE recurrence in multivariate analysis (hazard ratio, 3.39; 95% confidence interval, 1.07 to 10.67; p=0.037). Conclusions: Positive valve culture cases in early surgery for active IE have a significantly increased risk of recurrence compared with valve culture-negative cases and require careful management.

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Background Emergency or urgent surgery is often required in patients with papillary muscle rupture and active mitral valve infective endocarditis. The aim of this study was to analyze the outcomes of patients with active endocarditis who underwent emergency or urgent mitral valve repair. Methods From 2005 to 2014, 154 ischemic mitral regurgitation patients and 41 infective endocarditis patients underwent mitral valve repair in our institution; 23 had emergency operations due to papillary muscle rupture, and 18 with active infective endocarditis underwent urgent surgery. Results Cardiopulmonary bypass time (141.4 ± 43.3 versus 145.3 ± 46.5 min) and crossclamp time (77.7 ± 34.1 versus 79.2 ± 33.0 min) were similar in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, and major postoperative complications were comparable. Hospital mortality was 17.4% in the papillary muscle rupture subgroup and 8.4% in the elective ischemic mitral regurgitation subgroup. Cardiopulmonary bypass time (103.6 ± 37.0 versus 75.5 ± 20.8 min) and crossclamp time (61.7 ± 21.2 versus 45.3 ± 18.0 min) were significantly longer in infective endocarditis patients. There were no major complications or hospital deaths. Eight years postoperatively, overall survival was 94.4% and 86.5% in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, respectively ( p = 0.730). Overall survival was 100% in both infective endocarditis subgroups. Conclusion The feasibility and effectiveness of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis are satisfactory. Early and mid-term outcomes are comparable to those of elective operations.

P2761Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score

Introduction and aim Infective endocarditis (IE) is a complex and heterogeneous disease which might lead to cardiac surgery. For such cases, several perioperative risk predictive tools have emerged. We aimed to validate the recently developed PALSUSE, STS risk score for IE and modified AEPEI score and to compare their performances with the established EuroSCORE II. Methods We retrospectively accessed 128 patients from a single center registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Discrimination and calibration of models were assessed by receiver operating characteristic curve analysis and Hosmer-Lemeshow test. Results Perioperative mortality was 16.4% (n=21). The median EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score were 6.6% [IQR 3.5–18.2], 5 [IQR 3–7], 25 [IQR 16–32] and 1 [IQR 0–1.8], respectively. Discriminative power was numerically higher for EuroSCORE II (AUC of 0.83, 95% CI, 0.75–0.91) followed by STS risk score for IE (AUC of 0.75, 95% CI 0.64–0.86), PALSUSE (AUC of 0.74, 95% CI 0.64–0.86) and modified AEPEI (AUC of 0.68, 95% CI 0.57–0.788) – figure 1. The Hosmer-Lemeshow test showed good calibration for EuroSCORE II (p=0.08) and STS risk score for IE (p=0.03) but not for PALSUSE (p=0.65), modified AEPEI (p=0.12). Figure 1 Conclusion All scores adequately stratified peri-operative risk in active infective endocarditis, however EuroSCORE II in the overall comparison performed better in this population. Heterogeneity of performance of risk scores in different cohorts of infective endocarditis highlights the complexity of this disease.