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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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Endocarditis lesions found during surgery: a prospective registry
Session:
CO8 - Doença Valvular
Speaker:
Sara Ranchordás
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sara Ranchordás; Márcio Madeira; Paulo Veiga Oliveira; Marta Marques; José Calquinha; Miguel Sousa Uva; Miguel Abecasis; José Pedro Neves
Abstract
<p><u>Introduction</u></p> <p>Infective endocarditis is a rare but potentially fatal disease. Many factors may contribute to the increased mortality of this disease. Furthermore, pathologic lesions found during surgery are diverse, and its accurate prospective registry may help identify the best treatment methods. </p> <p><u>Aim</u></p> <p>Prospective register in a standardized coding form pathologic lesions found during endocarditis surgery. Evaluate predictors for early (<30days) and late (>30 days) mortality and embolic events.</p> <p><u>Methods</u></p> <p>Analysis of all patients with endocarditis lesions (active or remote) at the time of surgery. A total of 100 consecutive cases were included between june 2014 and august 2018. Pathological lesions were coded prospectively using a coding form suggested by Pettersson et al. where all endocarditis lesions are recorded according to type, location and size. Other data, such as medical history and diagnostic studies, was collected retrospectively. </p> <p><u>Results</u></p> <p>Mean age of patients was 59 years, 72% were male, 54% were in class NHYA III-IV heart failure pre-operatively. Endocarditis was prosthetic in 23% and active in 75% of cases. Embolic events were described in 41%– most frequently to the brain (22%). Pre-operative blood cultures were positive in 70% - staphylococci were the most frequent (33%).In echocardiogram, vegetations were seen in 77%, invasion in 24%, and valve integrity anomalies in 31% of patients. </p> <p>A summary of lesions found classified according to the coding form by Petterson et al. is presented in tables 1 and 2.</p> <p>Valve culture was negative in 73 cases. Staphylococci were the most frequently identified (14%). </p> <p>Early mortality was 9%. Mean EuroSCORE II was 9.4%. Cumulative survival at 4 years is 59.9%.Echocardiogram identifies vegetations, invasion and valve integrity anomalies accurately. No relation between microorganisms isolated and type of lesions was found. In univariate analysis, high blood pressure (<em>p=</em> 0.005), chronic kidney disease (<em>p=</em> 0.005) and creatinine level (<em>p=</em> 0.022), age (<em>p=</em> 0.011), NHYA III-IV heart failure (<em>p=</em> 0.003), EuroSCORE II (<em>p<</em> 0.001), valve integrity anomalies (surgery) (<em>p=</em> 0.016), prosthetic endocarditis (<em>p<</em> 0.001) and redo operation (<em>p=</em> 0.001) were significant predictors of early mortality. During follow up, prosthetic endocarditis (OR 3.276 (1.461-7.347)) and EuroSCORE II (OR 1.07 (1.043-1.098)) were significant predictors of mortality.</p> <p>Reduced mobility (<em>p=</em> 0.001), intravenous drug abuse (<em>p=</em> 0.007), vegetations (echocardiogram) (<em>p=</em> 0.009) and aortic valve vegetations (surgery) (<em>p=</em> 0.026) were significant predictors of embolic events.</p> <p><u>Conclusion</u></p> <p>Prosthetic endocarditis and EuroSCORE II are predictors of early and late mortality. Reduced mobility, vegetations and intravenous drug abuse increase risk of embolic events.Systematic coding of lesions is needed to allow harmonisation across centres paving the way for larger study populations.</p>
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