Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis
Abstract
1. Introduction
2. Materials and Methods
2.1. Inclusion Criteria
2.2. Definition of Primary and Secondary Endpoints
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Microbiology Yield
3.3. Risk Factors for IE
3.4. Comorbidities
3.5. Echocardiography and Localization of IE
3.6. IE Complications
3.7. Clinical Course and Treatment
3.8. Surgical Procedures
3.9. Postoperative Complications
3.10. Outcomes
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | Groups | |||
---|---|---|---|---|
Characteristics | N = 63 | NSG 1, N = 24 | SG 1, N = 39 | p-Value 2 |
Male sex, n (%) | 52 (83%) | 18 (75%) | 34 (87%) | 0.3 |
Age, median (IQ) | 70.00 (17.50) | 71.50 (20.00) | 68.00 (15.50) | 0.3 |
Age > 75 years old, n (%) | 16 (25%) | 9 (56%) | 7 (44%) | 0.08 |
Length of hospital stay, median (IQ) | 36.50 (23.75) | 30.50 (23.50) | 37.50 (20.25) | 0.2 |
Pathogens, n (%) | 0.3 | |||
Coagulase-negative Staphylococci | 6 (9.5%) | 1 (4.2%) | 5 (13%) | |
Enterococci | 19 (30%) | 9 (38%) | 10 (26%) | |
Negative | 5 (7.9%) | 0 (0%) | 5 (13%) | |
Others | 4 (6.3%) | 1 (4.2%) | 3 (7.7%) | |
Staphylococcus aureus | 8 (13%) | 4 (17%) | 4 (10%) | |
Streptococcus spp. | 21 (33%) | 9 (38%) | 12 (31%) | |
Time to negative blood cultures, days (IQR) | 8.00 (9.25) | 9.50 (9.25) | 8.00 (7.00) | 0.7 |
Valve culture performed, n (%) | / | / | 35 (90%) | |
Valve culture positive, n (%) | / | / | 5 (14%) | |
Localization, n (%) | 0.6 | |||
AM [aortic–mitral] | 50 (79%) | 21 (88%) | 29 (74%) | |
AT [aortic–tricuspidal] | 5 (7.9%) | 2 (8.3%) | 3 (7.7%) | |
MT [mitral–tricuspidal] | 6 (9.5%) | 1 (4.2%) | 5 (13%) | |
TP [tricuspidal–pulmonary] | 2 (3.2%) | 0 (0%) | 2 (5.1%) | |
Type of valve, n (%) | 0.050 | |||
NN [native–native] | 48 (76%) | 15 (63%) | 33 (85%) | |
NP [native–prosthetic] | 12 (19%) | 6 (25%) | 6 (15%) | |
PP [prosthetic–prosthetic] | 2 (3.2%) | 2 (8.3%) | 0 (0%) | |
Unknown | 1 (1.6%) | 1 (4.2%) | 0 (0%) | |
Risk factors for IE, n (%) | ||||
Cardiovascular procedure history | 17 (27%) | 10 (42%) | 7 (18%) | 0.047 |
ICD/PM at admission | 9 (14%) | 2 (8.3%) | 7 (18%) | 0.5 |
Intravenous drug use | 8 (13%) | 3 (13%) | 5 (13%) | >0.9 |
Anatomical alterations | 13 (21%) | 7 (29%) | 6 (15%) | 0.2 |
Skin lesions | 1 (1.6%) | 1 (4.2%) | 0 (0%) | 0.4 |
Gastrointestinal alterations | 8 (13%) | 4 (17%) | 4 (10%) | 0.5 |
History of rheumatic fever | 1 (1.6%) | 0 (0%) | 1 (2.6%) | >0.9 |
Recent dental procedures | 1 (1.6%) | 0 (0%) | 1 (2.6%) | >0.9 |
Comorbidities, n (%) | ||||
Chronic hepatitis | 10 (16%) | 4 (17%) | 6 (15%) | >0.9 |
Hemodialysis | 2 (3.2%) | 2 (8.3%) | 0 (0%) | 0.14 |
Type 2 diabetes | 14 (22%) | 8 (33%) | 6 (15%) | 0.12 |
HIV | 4 (6.3%) | 0 (0%) | 4 (10%) | 0.3 |
Cancer | 10 (16%) | 7 (29%) | 3 (7.7%) | 0.034 |
Immunosuppressive therapy | 9 (14%) | 7 (29%) | 2 (5.1%) | 0.021 |
Anticoagulant therapy | 14 (22%) | 8 (33%) | 6 (15%) | 0.12 |
Antiplatelet therapy | 10 (16%) | 6 (25%) | 4 (10%) | 0.2 |
Complications of infection, n (%) | ||||
Cardiac complications | 21 (33%) | 3 (13%) | 18 (46%) | 0.007 |
Embolic complications | 31 (49%) | 9 (38%) | 22 (56%) | 0.2 |
Cerebral emboli | 20 (32%) | 6 (25%) | 14 (36%) | 0.4 |
Spleen/kidney emboli | 12 (19%) | 3 (13%) | 9 (23%) | 0.3 |
Cutaneous emboli | 2 (3.2%) | 1 (4.2%) | 1 (2.6%) | >0.9 |
Spondylodiscitis | 7 (11%) | 1 (4.2%) | 6 (15%) | 0.2 |
Pulmonary emboli | 7 (11%) | 2 (8.3%) | 5 (13%) | 0.7 |
Septic shock | 2 (3.2%) | 1 (4.2%) | 1 (2.6%) | >0.9 |
Arrhythmias | 8 (13%) | 0 (0%) | 8 (21%) | 0.020 |
EV antibiotic duration, days (IQ) | 38.00 (17.25) | 32.00 (12.00) | 42.00 (22.00) | 0.12 |
Switch to oral antibiotics, n (%) | 11 (17%) | 5 (21%) | 6 (15%) | 0.7 |
In-hospital mortality, n (%) | 7 (11%) | 5 (21%) | 2 (5.1%) | 0.095 |
One-year survival, n (%) Unknown, n (%) | 41 (65%) 4 (6.3%) | 13 (54%) 0 (0%) | 28 (72%) 4 (10%) | 0.031 |
Total | Groups | |||
---|---|---|---|---|
Characteristics | N = 63 | Native Valves N = 49 (77.8%) | Prosthetic Valve(s) N = 14 (22.2%) | p-Value 1 |
Male sex, n (%) | 52 (82.5%) | 40 (81.6%) | 12 (85.7%) | 1.000 |
Age, median (IQR) | 70.0 (57.0–74.5) | 65.0 (56.0–74.0) | 71.5 (69.2–77.0) | 0.053 |
Length of hospital stay, days, median (IQR) | 36.5 (26.2–50.0) | 34.5 (26.0–50.0) | 38.5 (31.2–45.5) | 0.923 |
One-year survival | 41 (65.1%) | 37 (75.5%) | 4 (28.6%) | 0.003 |
Emboli | 31 (49.2%) | 24 (49.0%) | 7 (50.0%) | 1.000 |
Cerebral emboli | 20 (31.7%) | 16 (32.7%) | 4 (28.6%) | 1.000 |
Spleen or kidney emboli | 12 (19.0%) | 10 (20.4%) | 2 (14.3%) | 0.898 |
Skin emboli | 1 (1.6%) | 1 (2.0%) | 0 (0.0%) | 1.000 |
Osteomyelitis | 7 (11.1%) | 5 (10.2%) | 2 (14.3%) | 1.000 |
Pulmonary emboli | 7 (11.1%) | 6 (12.2%) | 1 (7.1%) | 0.957 |
Surgically treated | 39 (61.9%) | 33 (67.3%) | 6 (42.9%) | 0.176 |
In-hospital mortality | 7 (11.1%) | 3 (6.8%) | 4 (28.6%) | 0.052 |
Localization | Surgical Procedure | No. |
---|---|---|
Aortic–mitral [AM] (n = 29) | Double prosthetic valve Aortic prosthesis + mitral repair Mitral prosthesis + aortic repair Mitral prosthesis + tricuspidal repair | 16 (14 biological, 2 mechanical) 11 (9 biological, 2 mechanical) 1 (mechanical) 1 (mechanical) |
Mitral–tricuspidal [MT] (n = 5) | Mitral prosthesis + tricuspidal repair Tricuspid prosthesis + mitral repair Double repair | 2 (1 mechanical) 1 (biological) 2 |
Aortic–tricuspidal [AT] (n = 3) | Aortic prosthesis + tricuspidal repair | 3 (biological) |
Tricuspidal–pulmonary [TP] (n = 2) | Tricuspid prosthesis + pulmonary valve repair Pulmonary prosthesis + tricuspidal repair | 1 (biological) 1 (biological) |
Additional procedures | CABG Ascending aorta replacement Aortic root replacement | 8 (23%) 2 (6%) 1 (3%) |
Characteristics of SG | N = 39 |
---|---|
ICU stay, days (IQ) Cardiac surgery department stay, days (IQ) In-hospital mortality, n (%) | 2.00 (5.00) 8.00 (4.75) 2 (5%) |
Complications, n (%) AVB/Arrhythmias Post-op PM implantation Periprosthetic leak PNX Cardiac tamponade Pleural effusion Post-op dialysis | 16 (41%) 9 (25%) 1 (2.6%) 1 (2.6%) 2 (5.1%) 1 (2.6%) 1 (2.6%) |
EuroSCORE II, median (IQ) ECC time, minutes (IQ) Aortic cross-clamping time, minutes (IQ) | 7.00 (4.00) 156.00 (70.00) 119.00 (68.25) |
Timing of surgery, n (%) Non urgent Urgent | 21 (54%) 18 (46%) |
Variable | OR | IC 95% | p-Value |
---|---|---|---|
Cerebral emboli | 0.632 | 0.116–3.44 | 0.595 |
Cardiac complications | 2.17 | 0.358–13.11 | 0.400 |
Prosthetic valve | 0.300 | 0.0394–2.29 | 0.245 |
Age (by 1 year) | 0.957 | 0.879–1.04 | 0.957 |
Spleen/kidney emboli | 1.64 | 0.164–16.34 | 0.675 |
Urgent surgery | 0.222 | 0.0363–1.36 | 0.104 |
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Lerta, S.; Sangaletti, G.; Villano, V.A.; Puci, F.; Kushta, E.; Totaro, P.; Amoroso, F.; Magrini, G.; Valsecchi, P.; Bruno, R.; et al. Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis. J. Clin. Med. 2025, 14, 5589. https://doi.org/10.3390/jcm14155589
Lerta S, Sangaletti G, Villano VA, Puci F, Kushta E, Totaro P, Amoroso F, Magrini G, Valsecchi P, Bruno R, et al. Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis. Journal of Clinical Medicine. 2025; 14(15):5589. https://doi.org/10.3390/jcm14155589
Chicago/Turabian StyleLerta, Sonia, Gloria Sangaletti, Vincenzo Antonio Villano, Flavia Puci, Eraldo Kushta, Pasquale Totaro, Filippo Amoroso, Giulia Magrini, Pietro Valsecchi, Raffaele Bruno, and et al. 2025. "Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis" Journal of Clinical Medicine 14, no. 15: 5589. https://doi.org/10.3390/jcm14155589
APA StyleLerta, S., Sangaletti, G., Villano, V. A., Puci, F., Kushta, E., Totaro, P., Amoroso, F., Magrini, G., Valsecchi, P., Bruno, R., & Seminari, E. (2025). Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis. Journal of Clinical Medicine, 14(15), 5589. https://doi.org/10.3390/jcm14155589