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Prosthetic valve rocking motion: a look over the last ten years in a tertiary care center
Session:
SESSÃO DE POSTERS 50 - DIAGNÓSTICO E PROGNÓSTICO NA CIRURGIA CARDÍACA
Speaker:
Maria Resende
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.4 Infective Endocarditis – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Maria Resende; Rita Carvalho; Márcio Madeira; Sara Ranchordás; Inês Alves; João Aquino; Catarina Brizido; José Pedro Neves; Regina Ribeiras; Miguel Sousa-Uva
Abstract
<p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Introduction and aim: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Prosthetic valve dehiscence with abnormal rocking prosthetic motion (RPM) is a rare and underreported complication of infective endocarditis (IE). We aimed to analyze a recent cohort of IE-related RPM regarding their clinical characteristics, imaging, surgical findings and patient outcomes.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Retrospective, single-center study including all consecutive patients diagnosed with PRM due to IE between 2014-2024 at a tertiary care center. RPM was defined either by motion >15° in at least one plane by echocardiography (TTE/TEE) or presence of dehiscence of >50% of the annular ring intraoperatively.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Eleven patients were included (69 [32-89] years, 64% males). Main identifiable IE risk factors were previous IE (18%), presence of cardiac implantable electronic devices (18%), and dental procedures (9%). Only aortic (73%) and mitral (27%) valve prosthesis were involved, with multi-valvular EI in 36%. Most cases concerned biological prosthesis (73%), and all cases were late PVE. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Mean time from first symptoms to IE diagnosis was 57 [11-300] days, with </span></span><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">fever (73%) and heart murmur (55%) presenting as the main clinical findings. All patients were admitted for either congestive heart failure (64%) or cardiogenic shock (36%). Embolic events occurred in 27% of cases. Blood cultures were positive in 55%, and mostly found S. aureus and </span></span><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">E. faecalis. </span></span><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">RPM was diagnosed by echocardiography in 64% of patients, with the remaining patients being exclusively diagnosed intraoperatively. From those diagnosed by imaging, 29% were only visible on TEE. </span></span><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif"> By Duke’s classification, 55% had definite IE criteria and 45% possible IE. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Ten of the 11 patients underwent surgery (5 [1-14] days from IE diagnosis to intervention, mean EUROScore II 36,7 [8,3-87]%). The most common procedure was porcine aortic root prosthesis implantation (n=7), 1 root Commando procedure and 2 biological aortic and mitral prothesis implantations. After surgery, the main complication was acute kidney injury (45%), 1 patient had a stroke and 1 needed mechanical circulatory support. Three patients (30%) needed re-intervention. Mean ICU stay was 7 [1-26] days, and in-hospital mortality was 36%. During a median follow-up of 18 [0-93] months, all 7 discharged patients were alive and with no hospital readmissions.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p><span style="color:#000000"><strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">Conclusions</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Aptos Display",sans-serif">: Patients with RPM due to IE present as critically ill and require prompt diagnosis by multi-modality imaging including early TEE. Quick referral to the Endocarditis Team and urgent complex surgical correction when feasible might allow patient survival with low morbidity in the long term.</span></span></span></p>
Slides
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